Symptomatic Omphalomesentric Duct Anomalies in Children: Analysis from a Paediatric Surgery Department Catering Primarily to the Rural Population

Abstract

Introduction: Omphalomesenteric Duct (OMD) anomalies are rare congenital disorders of primitive yolk sac. The spectrum of OMD anomalies has varied clinical presentations. Aim: To study the spectrum and management of symptomatic OMD anomalies in children at a rural tertiary care centre. Materials and Methods: This was a retrospective study done at Uttar Pradesh University of Medical Sciences, Saifai, Etawah, a tertiary care centre located in rural part of Northern India. Medical records of all children less than 15 years of age who were diagnosed with symptomatic OMD anomalies and managed surgically between January 2016 to December 2019 (four years) were carefully analysed and data were recorded. The recorded parameters were age, sex, symptomatology, clinical presentation, intraoperative findings, surgical procedure performed, complications that developed during the early postoperative period, length of hospital stay and Histopathology Examination (HPE) of the specimens excised. The collected data were statistically analysed. A p-value <0.05 was considered statistically significant. Results: Records revealed that 40 children underwent surgeries for symptomatic OMD anomalies which constituted 6.21% of all surgeries (644) performed by the Department of Paediatric Surgery during January 2016 to December 2019 (four years). There were 29 males (72.5%) and 11 females (27.5%) (M:F=2.6:1). Out of 40 patients, 17 (42.5%) were infants and 23 (57.5%) were of post-infancy age. Mean age of cohort was 41.77 months. The three predominant clinical presentation in children were intestinal obstruction, acute abdomen and umbilical abnormalities. The commonest clinical presentation of the symptomatic OMD anomalies was umbilical abnormalities (50%). Clinical presentation of umbilical abnormality was significantly higher in infancy (p=0.0039*). The incidence of Meckel’s diverticulum was 50%. Wedge resection was the commonest surgical procedure performed (67.5%). On HPE, ectopic gastric mucosa was identified in 12 out of 40 patients (30%). Conclusion: Symptomatic OMD remnants have varied clinical presentation. Patients presenting with umbilical abnormalities are common in infancy. Presence of ectopic tissue is commoner in patients with symptomatic OMD remnants. Surgery is the treatment of choice.