• 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.

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Article received: May 25, 2018. Accepted for publication: Sep 13, 2018.