© 2021, Singh AP et al
Received Day: 20 Month: 05 Year: 2021
Accepted Day: 12 Month: 04 Year: 2022
J Pediatr Adolesc Surg. 2022; 2:
DOI: 10.46831/jpas.v2i1.96
Omphalomesenteric duct cyst containing gastric mucosa presenting with periumbilical excoriation
AP SinghI1 Department of Paediatric Surgery, Bhagwan Mahavir Hospital, Mahavir Nagar, Sumerpur, District – Pali, Rajasthan, India
DK Barolia I2 Department of Paediatric Surgery, Sir Padampat Mother And Child Health Institute, S.M.S. Medical College, Jaipur, Rajasthan, India
HV Bathia I3 Department of Anesthesia, Bhagwan Mahavir Hospital, Mahavir Nagar, Sumerpur, District – Pali, Rajasthan, India
VH Parmar I4 Department of Histopathology at Neuberg Supratech References Laboratories, Ahmedabad (NSRL)
BA Mehta I5 Department of Histoanatomic Pathology, Neuberg Supratech Reference Laboratory, Ahmedabad, Gujarat, India
Mehta ShraddhaI6 Department of Pathology, Bhagwan Mahavir Hospital, Mahavir Nagar, Sumerpur, District – Pali, Rajasthan, India
[corresp] Dr. Dinesh Kumar Barolia, Barolia Bhawan, Near Panchali Phatak, Srimadhopur, District – Sikar, Rajasthan, India, Pin code – 332715. E-mail: id-dbaroliarnt@gmail.com

CASE PRESENTATION

A 2-year-old male child presented with umbilical discharge (for 1.5 years), red-brown swelling at the umbilicus (since birth), and severe excoriation around the umbilicus (for 1 year). He was taking medicine from a local practitioner for umbilical swelling for one year. But there was no improvement. Gradually periumbilical excoriation worsened. On examination, the excoriated skin became black. He was investigated for routine hemogram, USG whole abdomen, and pre-anesthetic checkup. Ultrasonography showed umbilical sinus. After optimization, surgery was performed that showed a cystic swelling beneath the umbilicus, opening at the umbilicus. The end of cystic swelling was connected with the distal ileum (site for Meckel's diverticulum) with a fibrous band. The cyst and the band were excised (Fig. 1). Umbilicoplasty was done along with layered wound closure. The postoperative period was uneventful. Histopathology of the excised specimen showed a cystic lesion composed of ectopic gastric mucosa surrounded by muscle layer and fibroadipose tissue. This report interpreted it as an omphalomesenteric duct cyst with the ectopic gastric mucosa

DISCUSSION

Omphalomesenteric duct cyst is the least common variant of omphalomesenteric duct.[1] The omphalomesenteric duct is a connective tubular stalk between the midgut and yolk sac. During embryological development (between 5th and 9thweeks of gestation) and with fetal growth this duct became obliterated. Altered and hampered development of omphalomesenteric duct can present various remnants like persistent vitelline duct, Meckel’s diverticulum, omphalodiverticular band, mesodiverticular band, omphalomesenteric duct cyst (Meckel’s cyst or umbilical cyst), umbilical sinus, and umbilical polyp.[1], [2], [3] Histopathology of omphalomesenteric duct remnant resembles the small bowel. Occasionally ectopic gastric mucosa or pancreatic tissue are also found in omphalomesenteric duct remnants.[4], [5]

The presentation is variable from simple umbilical swelling to umbilical discharge, and intestinal obstruction. The umbilical discharge may be purulent (omphalitis), blood mixed (umbilical granuloma), urine (patent urachus or urachal cyst), and feculent (remnant of the omphalomesenteric duct)[7]. In a retrospective study of 132 pediatric patients containing omphalomesenteric duct remnants, we found only one case (0.75%) of omphalomesenteric duct cyst. Cyst was containing small bowel mucosa and not connected to bowel and umbilicus1. But in the index case, the cyst was lined by the ectopic gastric mucosa, and the cyst opened at the umbilicus. Unusually cysts communicate with the umbilicus. All reported cases tabulated in Table 1 showed communication with umbilicus except one reported by Iwasaki M et al.[6]

The ectopic gastric mucosa secretes gastric juice containing gastric acid. The gastric acid persistently discharged from the umbilicus and spread around the umbilicus causes chemical dermatitis and gradually excoriation occurs5. Persistent umbilical discharge with periumbilical excoriation after conservative management needed further evaluation and surgical exploration for definitive treatment.


Figures

Figure 1 

Cyst and the band were excised



Tables
[TableWrap ID: t1] Table 1 

Showing reported cases of omphalomesenteric duct cyst containing gastric mucosa


S.no. Reference year Age of patient Clinical and Peroperative findings Histopathology of specimen
1 Iwasaki M. et al, 2009 [6] 6 years Heterotopic gastric mucosa
2 Tamilselvan K. et al. 2012 [7] 6 months Persistent umbilical discharge with intermittent blood-stained fluid, periumbilical chemical dermatitis, cystic swelling beneath the umbilicus open at umbilicus Ectopic gastric mucosa
3 Jagtap A.B. et al. 2016 [8] 2.5 years Clear serous discharge fromthe umbilicus, erythema at infraumbilical region Gastric antral type mucosa
4 Reporting case 2 years Umbilical discharge, red-brown swelling at the umbilicus, severe excoriation around the umbilicus Ectopic gastric mucosa


Notes

n1Conflicts of interest. None declared

n2Source of Support: Nil

n3Author contributions: Author(s) declared to fulfill authorship criteria as devised by ICMJE and approved the final version. Authorship declaration form, submitted by the author(s), is available with the editorial office.

n4Consent to Publication: Author(s) declared taking informed written consent for the publication of clinical photographs/material (if any used), from the legal guardian of the patient with an understanding that every effort have been made to conceal the identity of the patient, however it cannot be guaranteed.

Acknowledgments

None


References
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