Symptomatic omphalomesenteric duct remnants in children.

ABSTRACT

BACKGROUND: The present study gathers a single institutional experience of symptomatic omphalomesenteric duct (OMD) remnants in children with an emphasis on the age and modes of presentation, the surgical intervention and the histopathological findings. METHODS: The data on children who underwent surgical treatment for symptomatic OMD remnants during a 17-year period were reviewed retrospectively, excluding incidental diverticulectomies. RESULTS: A total of 59 children with a median age of 36 months underwent operations for symptomatic OMD remnants. There were 48 boys and 11 girls. The presenting signs were gastrointestinal tract (GIT) obstruction in 21 (36%) patients, acute abdomen in 18 (31%), umbilical abnormalities in 17 (29%), and rectal bleeding in three (5%). Patients presenting with umbilical anomalies were significantly younger than others. At surgery, a wedge resection of the remnant was carried out in 32 cases and an ileal resection was carried out in 27. Children presenting with GIT obstruction underwent segmentary ileal resection more often than other groups. Histopathology revealed inflammation in 26 (44%) specimens, ectopic tissue in 18 (31%) and necrosis in four (7%). Ectopic gastric mucosa was detected in 15 specimens, pancreatic tissue in two and both gastric and pancreatic tissue in one. CONCLUSIONS: Symptomatic OMD remnants in children most commonly presented with GIT obstruction, acute abdomen and umbilical anomalies. Rectal bleeding was not a predominant finding in the present series. Surgery is curative and can safely be done either by way of wedge resection or ileal segmentary resection. Ectopic tissue is detected in approximately one third of symptomatic remnants.