A rare case of pediatric volvulus caused by a persistent omphalomesenteric cyst

  • Catarina Valpaços Pediatrics Department, Hospital de Santa Luzia, Unidade Local de Saúde do Alto Minho
  • Mariana Costa Pediatrics Department, Hospital de Santa Luzia, Unidade Local de Saúde do Alto Minho
  • Suzana Figueiredo Pediatrics Department, Hospital de Santa Luzia, Unidade Local de Saúde do Alto Minho
  • Ana Raquel Silva Pediatric Surgery Department, Hospital de Braga
  • Jorge Correia-Pinto Pediatric Surgery Department, Hospital de Braga
  • Angélica Osório Pediatric Surgery Department, Hospital de Braga
Keywords: Acute abdomen, Intestinal volvulus, Omphalomesenteric duct

Abstract

A persistent omphalomesenteric duct is one possible cause of small-bowel volvulus, a rare cause of acute abdomen in children. A four-year-old child was admitted to the Emergency Department with abdominal pain and incoercible vomiting, with neither abdominal guarding nor relevant abnormalities revealed in complementary diagnostic exams. Due to a significant clinical deterioration over a 48-hour observation period, the child was transferred to a tertiary hospital with pediatric surgery. An abdominal ultrasound revealing severe bowel distension and increased abdominal free fluid warranted an exploratory surgery, which identified a voluminous omphalomesenteric duct cyst. When symptomatic, treatment of this condition is consensual and consists of surgical excision of the anatomical abnormality, either by laparoscopy or conventional surgery. The latter was performed.
Conclusion: A persistent omphalomesenteric duct is a rare condition that generally requires a high level of clinical suspicion for diagnosis to be made, being most commonly detected during surgery. Associated complications and mortality rates are high, and a timely intervention is key, since surgical removal is the only treatment option.

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Published
2019-01-02
Section
Case Reports