Kafle Rukma Raj, Kandel Rakshya Arun, Bhandari Anupam, Thapa Bishwo Prakash Jung, Kadel Dhruba
Department of Emergency Medicine, Scheer Memorial Adventist Hospital (SMAH), Banepa 45210, Nepal.
Department of Radiology, Scheer Memorial Adventist Hospital (SMAH), Banepa 45210, Nepal.
Int J Surg Case Rep. 2025 Sep;134:111730. doi: 10.1016/j.ijscr.2025.111730. Epub 2025 Jul 24.
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.
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.
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.
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.
卵黄管（OMD）是一种将中肠与卵黄囊相连的胚胎结构。它通常在妊娠第9至18周之间闭锁。卵黄管囊肿是卵黄蒂的胚胎残余物。如果卵黄蒂没有完全闭锁，其各个部分可能会持续存在，从而产生许多病变，包括卵黄管囊肿。
一名14岁男性患者，既往无内科或外科病史，因绞痛性腹痛和呕吐就诊，出现了由卵黄管囊肿形成的带导致小肠梗阻的极其罕见病例。超声检查显示肠系膜淋巴结炎，最可能为结核性。腹部计算机断层扫描显示小肠扩张，因小肠壁增厚伴脂肪条索影提示小肠梗阻。在剖腹探查术中，发现距回盲瓣近端20 cm处有一个导致小肠梗阻的卵黄管，并将其切除，同时进行了肠系膜淋巴结活检。病理检查证实存在卵黄管残余纤维带。
卵黄管残余纤维带可能无症状，但可导致小肠梗阻，且在既往健康的个体中往往难以诊断。然而，系列腹部平片可明确诊断小肠梗阻，而增强计算机断层扫描可进一步提供有关梗阻部位和程度的信息，有助于指导手术干预。
尽管卵黄管残余是小肠梗阻的罕见原因，但应始终予以考虑，尤其是在无既往手术史的患者中。虽然手术治疗是复杂和严重病例的主要选择，但无症状的卵黄管残余通常不需要额外干预。
