Presumed septic shock from small-bowel obstruction due to a vitellointestinal remnant in a 12-year-old: successful surgical management - a case report.

BACKGROUND

Persistent vitellointestinal (omphalomesenteric) duct (VID) is an uncommon embryologic remnant that typically presents with painless bleeding, umbilical discharge, or mechanical small-bowel obstruction. Presentation with systemic sepsis or septic shock is exceedingly rare.

CASE PRESENTATION: A 12-year-old male presented with 4 days of high-grade fever, progressive abdominal pain, bilious vomiting and hypotension. Imaging demonstrated high-grade small-bowel obstruction with a transition point in the mid-to-distal ileum. After failed conservative management, emergency laparotomy revealed a 1 × 3 cm tubular vitelline remnant with fibrous omental adhesion causing mechanical obstruction. Excision, release of the band, and primary ileal repair were performed. The patient stabilized postoperatively and was discharged on day 5.

DISCUSSION: While VID anomalies classically cause localized gastrointestinal complaints, a systemic inflammatory response with circulatory collapse, consistent with septic shock, is uncommon and sparsely reported. Possible pathophysiologic mechanisms include bacterial translocation across ischemic or obstructed bowel, superinfection of a cystic remnant, or a non-infectious overwhelming inflammatory response to necrotic tissue. Because a clinical picture of presumed septic shock can obscure an underlying surgical cause, clinicians should consider VID anomalies in children with compatible abdominal findings. Prompt resuscitation, targeted evaluation for infection, early antimicrobial therapy when indicated, and timely surgical intervention are essential to prevent organ dysfunction.

CONCLUSION

VID can rarely present with systemic inflammatory response with circulatory collapse; recognition of this atypical pattern expedites lifesaving intervention.