The omphalomesenteric duct is an embryological structure ensuring the communication between the primitive intestine and the vitelline vesicle until the 7th week.

Its persistence can manifest as:

1)        in case of incomplete occlusion of the proximal part: Meckel's diverticulum (A) (see this term),

2)        in case of incomplete occlusion of the distal part:

-        an omphalo-mesenteric fistula (C), where mucus or fecaloid secretions come out of the umbilicus;

-        an enteric (or vitelline) cyst, either isolated (B) or communicating to the skin through the umbilicus, which manifests itself as a chronic oozing, infections or abscess;

-        an umbilical fistula in communication with an enteric cyst

-        an umbilical sinus: an oozing lesion at the level of the umbilicus that does not respond to local care (silver nitrate): it is an heterotopy of the intestinal mucosa

-        a persistent fibrous band between the intestine and the umbilicus, a potential cause for mechanical bowell obstruction.

The exeresis of the remnants of the omphalomesenteric duct requires a laparotomy with exploration of the antimesenteric side of the small intestine.

Anesthetic implications:

general anesthesia associated with a lumbar epidural or caudal block

References:

-         Moore T.C.
Omphalomesenteric duct malformations.
Semin Pediatr Surg 1996; 5:116-23

Updated April 2020