Omphalocele and patent omphalomesenteric duct with ileal prolapse in a syndromic baby: A case report and review of the literature.

INTRODUCTION: The vitellointestinal duct is an embryological remnant of the vitelline duct, which normally obliterates in the 5th to 9th week of gestation. Failure to obliterate the vitellointestinal duct may lead to diverse types of congenital intestinal malformations, including a patent vitellointestinal duct. CASE PRESENTATION: A 4-day-old female neonate presented to our hospital with a big protruding mass around the belly button. At presentation, she was acutely sick-looking in cardiorespiratory distress, cyanotic, grossly preterm, and had gross dysmorphic features. There was an umbilical area defect with herniated bowel covered with a sac with prolapsed bowel tissue with exposed mucosa having a T-shaped appearance. After a primary stabilization, the child underwent surgery, and we found a patent omphalomesenteric duct at the distal ileum, with the ileum prolapsing through it. After reducing the prolapse, the patent omphalomesenteric duct was wedge resected, and the ileum was anastomosed. She deteriorated further in the early post-operative days from decompensated heart failure due to the complex cyanotic congenital heart disease and died on the second postoperative day. DISCUSSION: The omphalomesenteric duct, also known as the vitelline duct, is an embryological structure that provides nutritional support to the developing fetus during early gestation. Under normal circumstances, it undergoes complete obliteration between the 5th and 7th weeks of gestation. However, in rare cases, it may persist and give rise to various complications, such as the passage of meconium through the umbilicus. In infrequent instances, as seen in our patient, the bowel may prolapse through a patent omphalomesenteric duct. CONCLUSION: Patent vitellointestinal duct is a rare anomaly that can be complicated by bowel prolapse through it, an emergency that needs urgent surgical correction.