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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 7  |  Issue : 2  |  Page : 102-104

Congenital hernia of the umbilical cord with patent vitello-intestinal duct in a newborn: A rare case


Department of Paediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India

Date of Web Publication10-Apr-2018

Correspondence Address:
Dr. Aditya Pratap Singh
Near The Mali Hostel, Main Bali Road, Falna, Pali, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcn.JCN_134_17

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  Abstract 


Congenital hernia of the umbilical cord is a less frequent entity in newborns and occasionally associated with other maladies. Sometimes, a large umbilical cord hernia is confused with small omphalocele. We report an unusual case of umbilical cord hernia associated with patent vitello-intestinal duct in a male newborn who underwent surgery and discharged with good general condition.

Keywords: Hernia of the umbilical cord, newborn, patent vitello-intestinal duct


How to cite this article:
Singh AP, Gupta AK, Tanger R, Garg D. Congenital hernia of the umbilical cord with patent vitello-intestinal duct in a newborn: A rare case. J Clin Neonatol 2018;7:102-4

How to cite this URL:
Singh AP, Gupta AK, Tanger R, Garg D. Congenital hernia of the umbilical cord with patent vitello-intestinal duct in a newborn: A rare case. J Clin Neonatol [serial online] 2018 [cited 2020 Sep 27];7:102-4. Available from: http://www.jcnonweb.com/text.asp?2018/7/2/102/229665




  Introduction Top


Umbilical cord is a location for local artery neuropathies, urachus, midgut herniation, abdominal wall defects, and congenital cysts. Umbilical cord-associated anomalies are a rare manifestation in the neonatal age.[1],[2] Congenital hernia of the umbilical cord incidence is estimated to be 1 in 5000, and unlike omphalocele, it is not linked with chromosomal anomalies, and association with other anomalies is rare although there is a loose association with intestinal anomalies, malrotation, and volvulus.[3] It usually has good prognosis after surgical repair. We describe an unusual case of hernia of the umbilical cord with patent vitello-intestinal duct (PVID) in a male newborn.


  Case Report Top


Parent of a newborn male presented to us with the complaint of meconium discharge from the umbilical swelling since birth. A male term newborn weighing 2.7 kg was born of consanguineous marriage and delivered through spontaneous vaginal delivery. There was no history of the drug intake antenatal. Antenatal ultrasonography could not perform due to rural area. After newborn resuscitation, the baby was carefully examined and found to have a normally inserted umbilicus with a bowel mucosa appeared at the single opening [Figure 1]. The patient was vitally stable and operated electively on the next day of admission. At surgery, the umbilical ring was patent with a loop of small bowel herniated through the ring to the base of umbilical cord. The extruded mucosa was mobilized off the umbilical cord and found to be a PVID. There was a tubular structure connected with the ileum. Wedge resection was performed [Figure 2]. The postoperative recovery was uneventful. The patient was discharged on the 5th postoperative day in a good clinical condition.
Figure 1: Hernia of the umbilical cord with patent vitello-intestinal duct

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Figure 2: Peroperative photograph showing wedge resection

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  Discussion Top


Congenital hernia of the umbilical cord is a different type of ventral abdominal wall defect, in which the bowel usually herniates into the base of normally inserted umbilical cord through a patent umbilical ring.

During the 3rd week of intrauterine life, there was a link between fetus intestine and yolk sac through a narrow tube called as omphalomesenteric duct, which it disappears at the end of the 7th week. There was a midgut physiological herniation to cord during the 5th and 7th week of pregnancy. Normally, during 10–12 weeks of intrauterine life, fetal intestine returns to abdominal cavity. At this time if a small part of the intestine cannot fully return the abdomen and stay in the umbilical cord, this leads to hernia of the umbilical cord.[4],[5]

Hernia of small intestine and sometimes other viscera to umbilical cord because of lack of full return to intestine is one of the uncommon diseases, and it is less explained in scientific textbooks and sometimes it is confused with small omphalocele. There is a real defect of abdomen wall in omphalocele, and in the hernia of umbilical cord, the anterior abdominal wall and umbilical ring are normal. Herniation to umbilical cord may include a small portion to entire small intestine or associated with a portion of large intestine.[6],[7],[8] Rarely, other abdominal viscera herniate into the umbilical cord. In one study, even one case of liver and gallbladder herniation to the umbilical cord has been reported.[9] PVID and its remnants may also be found inside the umbilical cord.[10]

In our infant, a loop of small intestine was herniated into the umbilical cord ring and vitelline duct patency was seen and wedge resection and restoration of umbilical cord were performed. Although restoration of umbilical cord hernia is usually a simple operation with good result, its complications are rarely seen.

During the past decades, antenatal diagnosis of hernia of umbilical cord was reported on prenatal ultrasound and magnetic resonance imaging findings.[11] For correct clinical diagnostics, it is mandatory to look carefully for the presence of any true abdominal wall defect, umbilical ring, and the basis for the presence of skin collar fold so that the condition could not be misdiagnosed.[12]


  Conclusion Top


It is a very rare association of the hernia of umbilical cord with PVID. Any unusual thickening of the base of the cord along with even the fistula opening to its side should alert a physician to the existence of these combined anomalies. If this is misdiagnosed, clamping of the umbilical cord after birth can cause iatrogenic atresia of the ileum.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

We would like to acknowledge Dr. Neelam Dogra, Anesthesiologist, Senior Professor, SMS Medical College, Jaipur.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Carlisle EM, Mezhir JJ, Glynn L, Liu DC, Statter MB. The umbilical mass: A rare neonatal anomaly. Pediatr Surg Int 2007;23:821-4.  Back to cited text no. 1
[PUBMED]    
2.
Mirza B, Ali W. Distinct presentations of hernia of umbilical cord. J Neonatal Surg 2016;5:53.  Back to cited text no. 2
    
3.
Achiron R, Soriano D, Lipitz S, Mashiach S, Goldman B, Seidman DS, et al. Fetal midgut herniation into the umbilical cord: Improved definition of ventral abdominal anomaly with the use of transvaginal sonography. Ultrasound Obstet Gynecol 1995;6:256-60.  Back to cited text no. 3
    
4.
Raicevic M, Filipovic I, Sindjic-Antunovic S. Hernia of the umbilical cord associated with a patent omphalomesenteric duct. J Postgrad Med 2017;63:58-9.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Mirza B, Saleem M. Hernia of umbilical cord with congenital short gut. J Neonatal Surg 2014;3:26.  Back to cited text no. 5
    
6.
Mirza B, Mirza A, Hashim I, Saleem M. Hernia of umbilical cord: Report of three unusual cases. J Neonatal Surg 2015;4:16.  Back to cited text no. 6
    
7.
Haas J, Achiron R, Barzilay E, Yinon Y, Bilik R, Gilboa Y, et al. Umbilical cord hernias: Prenatal diagnosis and natural history. J Ultrasound Med 2011;30:1629-32.  Back to cited text no. 7
    
8.
Pal K, Ashri H, Al Wabari A. Congenital hernia of the cord. Indian J Pediatr 2009;76:319-21.  Back to cited text no. 8
    
9.
Hasaniya NW, Premaratne S, Varnes PM, Shin D, Shim W. Hernia into the umbilical cord with incarceration of liver and gallbladder in a newborn. J Pediatr Surg Case Rep 2013;1:432-3.  Back to cited text no. 9
    
10.
Gys B, Demaeght D, Hubens G, Ruppert M, Vaneerdeweg W. Herniation of a Meckel's diverticulum in the umbilical cord. J Neonatal Surg 2014;3:52.  Back to cited text no. 10
    
11.
Ono K, Kikuchi A, Takikawa KM, Hiroma T, Yoshizawa K, Sunagawa S, et al. Hernia of the umbilical cord and associated ileal prolapse through a patent omphalomesenteric duct: Prenatal ultrasound and MRI findings. Fetal Diagn Ther 2009;25:72-5.  Back to cited text no. 11
    
12.
Waqas Ali S, Arain A. Large hernia of umbilical cord misdiagnosed as omphalocele. J Neonatal Surg 2015;4:36.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2]


This article has been cited by
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Formosan Journal of Surgery. 2019; 52(6): 201
[Pubmed] | [DOI]



 

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