WOFAPS 2025 8th World Congress of Pediatric Surgery

Gülbin Yazgan, Sabri Cansaran, Ayşenur Celayir

University of Health Sciences, Turkey. Istanbul Zeynep Kamil Maternity and Children's Diseases Health Training and Research Center, Department of Pediatric Surgery, Istanbul

Introduction: Omphalocele is a congenital defect caused by failure of the anterior abdominal wall to close,resulting in herniation of intra-abdominal organs like intestines and/or liver through the umbilical ring,covered by peritoneum.The omphalomesenteric duct,a temporary embryonic connection between yolk sac and midgut,usually obliterates by weeks 7–9; failure may cause Meckel’s diverticulum or, rarely, intestinal prolapse. Here, we present a-neonate with omphalocele accompanied by intestinal prolapse through a patent omphalomesenteric duct.

Case Presentation: A 32-week and 4-day male-neonate weighing 2160grs,born vaginally to a-22-year old G1P0 mother whose labor was initiated due to vaginal prolapse and without prenatal diagnosis, was urgently consulted to us with preliminary diagnosis of gastroschisis. On examination,an-omphalocele sac with a-base diameter of 5cm containing intestinal loops was observed. Superior to the-sac and near its base, defect was noted,through which intestinal loops had prolapsed. The visibility of both proximal and distal bowel ends in the prolapsed segment led to a-preoperative diagnosis of intestinal prolapse through a-patent omphalomesenteric duct associated with omphalocele(Figure 1). Following anesthesia induction, the prolapsed bowel loops were reduced(Figure 2). A circumferential incision was made at skin margin of the omphalocele sac to enter the abdominal cavity. Exploration revealed dilated bowel segments prolapsed through a-2cm omphalomesenteric duct,with no pathology found(Figure 3). Approximately 10cm of dilated ileal segment involving the patent duct was resected.After preparing the bowel ends for anastomosis,the distal end was spatulated on the antimesenteric side due to a-2:1 diameter discrepancy. No leakage was observed upon anastomosis, and bowel continuity was confirmed. After primary repair of the omphalocele, umbilicoplasty was performed(Figure 4).The patient was started on oral feeding on postoperative day 4,and follow-up has no complications.

Conclusion: The prognosis of omphalocele with intestinal prolapse through a patent omphalomesenteric duct varies due to unique morbidities and complications of each anomaly. Early diagnosis and surgery enable successful outcomes.