Small bowel obstruction secondary to band formation by an omphalomesenteric cyst - A case report.

INTRODUCTION

The omphalomesenteric duct (OMD) is an embryologic structure that connects the midgut to the yolk sac. It usually obliterates between the 9th and 18th weeks of gestation. The omphalomesenteric duct cyst is an embryologic remnant of the yolk stalk. If the yolk stalk does not obliterate completely, various portions may persist, giving rise to many entities, including an omphalomesenteric duct cyst.

PRESENTATION OF CASE: An extremely rare case of a band formed by an omphalomesenteric cyst causing small bowel obstruction is presented in a 14-year-old male patient with no previous medical or surgical history who presented with colicky abdominal pain and vomiting. Ultrasonography revealed mesenteric lymphadenitis, most likely of tuberculous origin. Computed tomography of the abdomen demonstrated dilated small bowel with small bowel obstruction due to small bowel wall thickening showing fat strandings. In exploratory laparotomy, an OMD causing small bowel obstruction 20 cm proximal to the ileocecal valve was identified and resected, along with a mesenteric lymph node biopsy. Pathological investigation confirmed the presence of an OMD remnant fibrous band.

DISCUSSION: OMD remnant fibrous bands can be asymptomatic but can lead to obstruction in the small bowel and can often be difficult to diagnose in a previously healthy individual. However, serial plain abdominal X-rays can definitively establish a diagnosis of small bowel obstruction, while contrast- enhanced computed tomography can further provide information about the site and level of obstruction and is helpful in guiding surgical intervention.

CONCLUSION

Although an OMD remnant is a rare cause of small bowel obstruction, it should always be kept in consideration, especially in patients with no previous surgical history. While surgical therapy is the primary option for complicated and severe cases, asymptomatic OMD remnants typically do not require additional intervention.