Bahrami-Motlagh Hooman, Sadeghi Maryam, Amerifar Maryam, Sabeti Shahram, Rezaee Seyed Parviz, Peyvandi Hassan
Department of Radiology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Radiology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Int J Surg Case Rep. 2022 May;94:107004. doi: 10.1016/j.ijscr.2022.107004. Epub 2022 Mar 30.
The omphalomesenteric duct (OMD) usually involutes by the ninth gestational week. If this obliteration fails, OMD remnant will result in different pathologies mostly in the pediatrics and infrequently in adults. The most well-known OMD remnant disease is Meckel's diverticulum. Omphalomesenteric cyst is rather rare, and their combination is even more exceptional with few cases in literature.
We present an adolescent patient with nausea and vomiting and occasional periumbilical abdominal pain who was diagnosed with concurrent omphalomesenteric cyst and ileal diverticulum, causing internal hernia and bowel obstruction that underwent surgery.
OMD remnants mostly present in childhood with symptoms of intestinal obstruction, and rarely internal hernias for which conservative management is usually not curative, warranting surgery. Imaging presence of cystic lesion in mid abdomen in young patient with bowel obstruction should raise the suspicion for OMD remnants. Presence of OMD cyst together with Meckel's diverticulum necessitates more extensive resection, rare concurrence which is better to be prepared for in advance.
Preoperative radiologic workup is helpful to diagnose the obstruction and its probable cause. Presence of periumbilical cyst should raise the suspicion of OMD remnant specially in young adults with previous episodes of crampy abdominal pain and obstruction without history of abdominal surgery. Being familiar with possible concurrence of OMD cyst and Meckel's diverticulum will increase preparedness at the time of surgery.
卵黄管（OMD）通常在妊娠第9周时退化。如果这种闭塞失败，卵黄管残余会导致不同的病理状况，主要发生在儿科，在成人中较少见。最著名的卵黄管残余疾病是梅克尔憩室。卵黄管囊肿相当罕见，它们同时出现的情况更为罕见，文献中仅有少数病例报道。
我们报告一名青少年患者，有恶心、呕吐症状，偶尔有脐周腹痛，被诊断为同时患有卵黄管囊肿和回肠憩室，导致内疝和肠梗阻，接受了手术治疗。
卵黄管残余大多在儿童期出现肠梗阻症状，很少导致内疝，保守治疗通常无法治愈，需要手术治疗。对于肠梗阻的年轻患者，腹部中部出现囊性病变的影像学表现应引起对卵黄管残余的怀疑。卵黄管囊肿与梅克尔憩室同时存在需要更广泛的切除，这种罕见的同时出现情况最好提前做好准备。
术前影像学检查有助于诊断梗阻及其可能的原因。脐周囊肿的出现应引起对卵黄管残余的怀疑，特别是在有腹部绞痛和梗阻发作史但无腹部手术史的年轻成年人中。熟悉卵黄管囊肿与梅克尔憩室可能同时出现的情况将增加手术时的准备程度。
