Summary about Disease
An omphalomesenteric duct remnant (also known as a vitelline duct remnant) is a congenital anomaly. During fetal development, the omphalomesenteric duct (also called the vitelline duct) connects the developing gut to the yolk sac, providing nourishment. Normally, this duct obliterates (disappears) between the 5th and 9th week of gestation. When this obliteration fails, various remnants can persist, including a Meckel's diverticulum (most common), omphalomesenteric cyst, omphalomesenteric sinus, or a fibrous band connecting the ileum to the umbilicus. These remnants can cause abdominal pain, bleeding, bowel obstruction, or infection.
Symptoms
Symptoms vary depending on the type of remnant and any complications that arise. Common symptoms include:
Meckel's Diverticulum: Abdominal pain (often mimicking appendicitis), rectal bleeding (often painless in children), bowel obstruction, diverticulitis (inflammation of the diverticulum), umbilical discharge or inflammation.
Omphalomesenteric Cyst: Palpable abdominal mass near the umbilicus, abdominal pain.
Omphalomesenteric Sinus: Persistent umbilical discharge, umbilical infection (omphalitis).
Fibrous Band: Bowel obstruction, volvulus (twisting of the intestine).
Causes
The cause is incomplete obliteration of the omphalomesenteric duct during fetal development. The specific reasons for this failure are not fully understood, but it is considered a developmental defect and not typically linked to specific environmental factors or maternal behaviors during pregnancy.
Medicine Used
Medications are used to treat complications arising from an omphalomesenteric duct remnant, rather than the remnant itself. These may include:
Antibiotics: For infections like diverticulitis or omphalitis.
Pain relievers: For abdominal pain.
IV fluids and electrolytes: For dehydration related to vomiting or bowel obstruction.
H2 Blockers or PPI's: to prevent ulcer formation when bleeding The definitive treatment is usually surgical removal of the remnant.
Is Communicable
No, an omphalomesenteric duct remnant is not communicable. It is a congenital anomaly, meaning it is present at birth due to a developmental defect. It cannot be spread from person to person.
Precautions
There are no specific precautions to prevent an omphalomesenteric duct remnant, as it is a congenital condition. Prenatal care is important for monitoring fetal development, but it cannot prevent this specific defect. If a remnant is diagnosed, close monitoring for symptoms and prompt medical attention for any complications are important.
How long does an outbreak last?
There is no outbreak associated with omphalomesenteric duct remnants. The condition itself is a congenital defect present from birth, not an infectious disease. Complications arising from the remnant (like infection) will have a duration dependent on the severity and treatment.
How is it diagnosed?
Diagnosis depends on the type of remnant and the presence of symptoms. Methods include:
Physical Examination: To identify a palpable mass or umbilical discharge.
Imaging Studies:
Ultrasound: Can visualize cysts or fluid collections.
CT Scan: Can help identify diverticulitis, bowel obstruction, or other complications.
Meckel's Scan (Technetium-99m Pertechnetate Scan): Specific for detecting gastric mucosa within a Meckel's diverticulum (as it uptakes the tracer).
Barium Studies: May be used to visualize the small intestine.
Exploratory Laparoscopy or Laparotomy: May be necessary for diagnosis, particularly if other tests are inconclusive.
Timeline of Symptoms
The timeline of symptoms is highly variable:
At Birth: Some remnants, like omphalomesenteric sinuses, may present immediately with umbilical discharge.
Infancy/Childhood: Meckel's diverticula may present with painless rectal bleeding, intussusception, or bowel obstruction.
Adulthood: Some individuals remain asymptomatic for life, while others may experience symptoms later in life due to complications like diverticulitis or bowel obstruction. The symptoms are not linked to age, but related to specific complication of the remnant.
Important Considerations
Asymptomatic Remnants: Some individuals with omphalomesenteric duct remnants may never experience symptoms. However, even asymptomatic remnants can potentially lead to complications later in life.
Surgical Resection: The most common treatment is surgical removal of the remnant, especially if symptomatic or if complications arise.
Differential Diagnosis: Symptoms can mimic other abdominal conditions (e.g., appendicitis), so a thorough evaluation is crucial.
Increased Risk of Intussusception and Volvulus: The presence of a Meckel's diverticulum or fibrous band can increase the risk of these complications, particularly in children.
Long-Term Follow-up: After surgical resection, long-term follow-up is typically not required unless complications arise.