- Anomalies of omphalomesenteric vessel remnants in gastroschisis and their role in the surgical tactics in this pathology
Anomalies of omphalomesenteric vessel remnants in gastroschisis and their role in the surgical tactics in this pathology
PERINATOLOGY AND PEDIATRIC. UKRAINE. 2018.3(75):68-75; doi 10.15574/PP.2018.75.68
Sliepov О. К., Ponomarenko O. P., Migur M. Yu.
SI Institute of Pediatrics, Obstetrics and Gynecology named after academician O. Lukyanova of the National Academy of Medical Sciences of Ukraine, Kyiv
Objective: to study the frequency of non-obliterated omphalomesenteric (vitelline) arteries in newborns with gastroschisis and their anatomical features; to develop surgical tactics for this pathology.
Materials and methods. A retrospective chart review of 63 newborns with gastroschisis, who underwent surgical correction of the defect during the period of 2006–2018, was carried out. In total 7 newborns with gastroschisis and non-obliterated vitelline artery remnants were enrolled to the study.
Results. A diameter of non-obliterated vitelline artery remnants ranged from 1 mm to 5 mm (on average — 2.4±0.53 mm), and their length made up from 4.0 cm to 8.0 cm (on average — 6.1±0.59 cm). The non-obliterated vitelline artery remnants were represented by a fibrous cord, which took its rise from the mesenteric root of the ileum at a distance of 10 cm to 30 cm from the ileocaecal angle, threw over its antimesenteric border (causing or not its compression) and fixed in the split umbilical ring and the penetration defect of the anterior abdominal wall, passing free through the latter (n=3) or connecting with its edge (superior or right) (n=4). Clinically significant compression of the ileum with high-grade (n=1) and moderate (n=1) its stenosis or obstruction was diagnosed in 2 newborns with gastroschisis. In other cases, signs of the ileal obstruction (n=5) were not found, although in one of these cases there was its slight compression observed.
Conclusions. The non<obliterated omphalomesenteric (vitelline) arteries are abnormal vessels of the yolk sac. According to our data, they are found in 11.1% of newborns with gastroschisis and may cause ileal obstruction of compression origin, which requires appropriate treatment.
Key words: gastroschisis, omphalomesenteric (vitelline) artery, surgical tactics, ileal obstruction, newborns, children.
1. Sliеpov OK, Grasyukova NI, Wevelsky VL et al. (2014). Results of "Surgery of the first minutes" in the treatment of gastroschisis. Perinatologiya i pediatriya. 4: 18–23. https://doi.org/10.15574/PP.2014.60.18
2. Sliepov O, Migur M, Ponomarenko O et al. (2018). The Impact of Eventrated Organs Status on the Clinical Course and Prognosis of Simple Gastroschisis. Sovremennaya pediatriya. 1: 97–102. https://doi.org/10.15574/SP.2018.89.97
3. Benirschke K, Kaufmann Р. (1990). Pathology of the Human Placenta: Second edition. New York: Springer Science & Business Media: 180–192. https://doi.org/10.1007/978-1-4757-4193-3
4. Driver CP, Bruce J, Bianchi A et al. (2000). The contemporary outcome of gastroschisis. J. Pediatr. Surg. 35: 1719–1723. https://doi.org/10.1053/jpsu.2000.19221; PMid:11101722
5. D?Antonio F, Viragone C, Risso G et al. (2015). Prenatal risk factors and outcomes in gastroschisis: a meta-analysis. Pediatrics. 136: 159–169.
6. Ghionzoli M, James CP, David AL et al. (2012). Gastroschisis with intestinal atresia/predictive value of antenatal diagnosis and outcome of post-natal treatment. Pediatr. Surg. 47 (2): 322–328. https://doi.org/10.1016/j.jpedsurg.2011.11.022; PMid:22325384
7. Hansraj N, Larabee Shannon M, Lumpkins Kimberly M et al. (2016). Anomalous mesenteric vessel — a rare etiology of intermittent partial small bowel obstruction. Journal of Surgical Case Reports. 12: 1–3. https://doi.org/10.1093/jscr/rjw209
8. Holland A, Walker K, Badawi N. (2004). Gastroschisis: an update. Pediatr. Sur. Int. 26: 871–878. https://doi.org/10.1007/s00383-010-2679-1
9. Jalil O, Radwan R, Rasheed A et al. (2012). Congenital band of the vitelline artery remnant as a cause of chronic lower abdominal pain in an adult: Case report. Int. J. Surg. Case Rep. 3 (6): 207–208. https://doi.org/10.1016/j.ijscr.2012.01.011; PMid:22466111 PMCid:PMC3324705
10. Kronfli R, Bradnock TJ, Sabharwal A (2010). Intestinal atresia in association with gastroschisis: a 26-year review. Pediatr. Surg. Inter. 26: 891–894. https://doi.org/10.1007/s00383-010-2676-4; PMid:20676892
11. Lao OB, Larison C, Garrison MM et al. (2010). Outcomes in neonates with gastroschisis in US children's hospitals. Am. J. Perinatol. 27: 97–101. https://doi.org/10.1055/s-0029-1241729; PMid:19866404 PMCid:PMC2854024
12. Long AM, Court J, Morabito A et al. (2011). Antenatal diagnosis of bowel dilatation in gastroschisis is predictive of poor postnatal outcome. J. Pediatr. Surg. 46 (6): 1070–1075. https://doi.org/10.1016/j.jpedsurg.2011.03.033; PMid:21683200
13. Mastroiacovo P, Lisi A, Castilla EE et al. (2007). Gastroschisis and associated defects: an international study. Am. J. Med. Genet. A. 1; 143A (7): 660–671.
14. Michopoulou AT, Germanos SS, Ninos AP et al. (2013). Vitelline artery remnant causing intestinal obstruction in an adult. Surgery. 54 (5): 1137–1138. https://doi.org/10.1016/j.surg.2012.06.034; PMid:22920945
15. Moore TC (1996). Omphalomesenteric duct malformations. Semin. Pediatr. Surg. 5 (2): 116–123. PMid:9138710
16. Prust FW, Abouatme J. (1969). Vitelline artery causing small bowel obstruction in an adult. Surgery. 65 (4): 716–720. PMid:5774445
17. Robert S. Hollabaugh, E. Thomas Boles Jr. (1973). The management of gastroschisis. J. of Ped. Surg. 8 (2): 263–270. https://doi.org/10.1016/S0022-3468(73)80094-6
18. Stoll C, Alembik Y, Dott B. (2008). Omphalocele and gastroschisis and associated malformations. Am. J. Med. Genet. 146 (20): 1280–1285. https://doi.org/10.1002/ajmg.a.32297; PMid:18386803
Article received: May 25, 2018. Accepted for publication: Sep 13, 2018.