= Abstract =
A clinical Study of Vitelline Duct and Vessel Remnants
Jae Young Choi, M.D., Poong Man Jung, M.D.
Department of Surgery, Hanyang University, College of Medicine
Seoul, Korea
Of 72 patients with vitelline duct and vessel remnants, 45 (62.5 %) had symptomatic lesions. The mean age of the patients was 27.9 months. Males predominated (4.6 : 1). There were 22 cases of Meckel's diverticulum, 6 of Meckel's diverticulum attatched to the umbilicus with a fibrous band, 6 cases of patent vitelline duct, 5 cases of vitelline artery remnants as a fibrous band and 2 cases each of umbilical sinus and polyp, and vitelline cyst. Twenty-three patients (51 %) presented with intestinal obstruction, 6(13 %) with rectal bleeding, 4(9 %) with perforated Meckel's diverticulum, 5 with intestinal juice drainage through umbilicus, 5 with umbilical lesions, 1 with abdominal mass, and 1 with sepsis. Intestinal obstruction due to fibrous band developed during infancy(average age; 4.6 months). Seventeen asymptomatic Meckel's diverticulum, 8 obliterated vitelline artery remnants and 1 vitelline vein remnant as fibrous band, and 1 vitelline cyst were found incidentally at laparotomy. About 82 % of the complicated Meckel's diverticulum presented in infants and children less than 4 years of age.
Index Words: Vitelline duct remnant, Omphalomesenteric duct remnant, Vitelline artery rem
nant, Vitelline vein remnant
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- 27-
Table 1. Demogrphy of 72 Cases of the Vitelline Duct and Artery Remnants
Age(month) Symptomatic Asymptomatic
Male
Under 1 8
1 to 24 15
25 to 48 7
Over 49 7
Total 37
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Table 2. Age Distribution of Comlications of Meckel's Diverticulum
Age (month) Int, obstruction Bleeding Perforation
Under 1 0 0 0
1 to 24 11
25 to 48 3
Over 49 4
Total 18
3
3
0
6
- 28-
1
2
1
4
Total ( %)
O( 0)
15( 53.6)
8( 28.6)
5( 17,8)
28(100)
Table 3. Associated Diseases of Vitelline Duct and Artery Remnants(N = 27)
No. of diseases
Imperforate anus 7
Gastroschisis 5
Intestinal atresia 4
Patent urachus 3
Annular pancreas 3
Hirschsprung's disease 3
Intestinal malrotation 3
Omphalocele 2
In tussnscepti on 2
Conjoined twin 2
Asplenia syndrome 1
Diaphragmatic hernia 1
Wilms' tumor 1
Umbilical hernia 1
Renal agenesis 1
Spina bifida 1
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Table 4. Type of Symptomatic Vitelline Duct Remnants
Vitelline duct remnant
Meckel's diverticulum
leading point of intussusception
bleeding
diverticulitis with perforation
Diverticulum attached to the umbilicus with band
Patent omphalomesenteric duct
Umbilical polyp
Vitelline cyst
Umbilical sinus
Vitelline artery remnant as band
Vitelline vein remnant as band
Total
- 29-
No of cases
40
22
12
6
4
6
6
2
2
2
5
0
45
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Table 5. Clinical Features of Bleeding Meckel's diverticulum
No. of Sex Age RI cases scan
1 F 11m + 2 F 1yr4m + 3 F lyr4m + 4 M 2yr6m
5 F 3yrlm + 6 M 3yrBm +
Hgb(fm/ dl
9.7
9.3
10.1
7.4
6.0
5.3
Previous bleeding episodes
two
none
two
three
none
three
Histologic findings
G(+)
G(+)/P(+)
G(+)
G(+)
RI scan: 99"'Tc-pertechnetate scan, G: Gastric mucosa, P: Pancreatic tissue
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Table 6. Clinical Features of Perforated Meckel's Diverticulum
No. of Sex Age Chief complaints Preop. diagnosis Gastric cases mucosa
1 M 2yr Pain, melena Ruptured MD + 2 M 2yr4m Distension Panperitonitis
3 M 2yr9m Distension, vomiting Intestinal obstruction
4 M 14yrl0m Pain, fever Appendicitis
MD:Meckel's diverticulum
- 30-
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