Symptomatic vitelline duct anomalies in children : paediatric surgery

ABSTRACT

A wide variety of anomalies may occur as a result of the vitelline duct (VD) failing to obliterate completely. Most reports on symptomatic VD focus on Meckel's diverticulum; while other anomalies are given little attention. A retrospective review was conducted at our institution. According to the records 18 symptomatic children with VD anomalies were seen over 22 years; including 10 boys and 8 girls aged 11 days - 14 years (median 7.5 months). Twelve patients aged below 10 years (median 28 days) had patent vitelline ducts (PVDs); 3 children aged 13 months; 13 years and 14 years respectively had Meckel's diverticulum (MD); presenting as inflammation; tapeworm incarceration and volvulus respectively. Two patients; both 8 years old; had umbilical sinus; and a 3- year-old had a vitelline cyst. Only 1 patient with PVD had an associated anomaly (intestinal malrotation). The diagnosis of PVD was obvious clinically; but in 1 patient the fistula was demonstrated by fistulogram. The diagnosis of MD was intraoperative in all 3 patients. Treatment was by various types of resection for PVD and MD and excision for umbilical sinuses and cysts. One patient with PVD developed postoperative intestinal obstruction from adhesions; requiring re-laparotomy and adhesiolysis. Two patients with PVD died from sepsis and anaestheticrelated complications; respectively. Although MD is the most commonly VD anomaly; PVD is the most common symptomatic presentation in our environment