Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2021; 9(36): 11228-11236
Published online Dec 26, 2021. doi: 10.12998/wjcc.v9.i36.11228
Surgical perspectives of symptomatic omphalomesenteric duct remnants: Differences between infancy and beyond
Ayoung Kang, Soo-Hong Kim, Yong-Hoon Cho, Hae-Young Kim
Ayoung Kang, Soo-Hong Kim, Hae-Young Kim, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan 50612, South Korea
Yong-Hoon Cho, Department of Surgery, Pusan National University School of Medicine, Yangsan 50612, South Korea
Yong-Hoon Cho, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, South Korea
Author contributions: Cho YH and Kim SH conceptualized this study; Kang A, Kim SH, and Cho YH were involved in the study design, data collation, analysis, interpretation of results, and initial draft of manuscript; Kang A, Kim SH, Cho YH, and Kim HY reviewed the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Pusan National University Yangsan Hospital Institutional Review Board, No. 05-2020-111.
Informed consent statement: The requirement for informed consent was waived. This was a retrospective study. Therefore, it was impossible to get consent from patients and their guardians in advance. This study data did’t use data that could be used to identify the participants, and it may be published in a journal worthy of being open to the public after collecting data of treatments and operations for the past 12 years based on medical records only.
Conflict-of-interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong-Hoon Cho, MD, PhD, Full Professor, Department of Surgery, Pusan National University School of Medicine, No. 49 Busandaehak-ro, Yangsan 50612, South Korea. choyh70@pusan.ac.kr
Received: June 21, 2021
Peer-review started: June 21, 2021
First decision: September 28, 2021
Revised: September 29, 2021
Accepted: November 14, 2021
Article in press: November 14, 2021
Published online: December 26, 2021
Abstract
BACKGROUND

The clinical manifestations of omphalomesenteric duct remnant (OMDR) can vary with the age at diagnosis, from asymptomatic incidental findings to symptoms related to gastrointestinal complications. The lifelong complication rates are reported as 4%-34%, and complications are more common in patients younger than 2 years of age. The authors attempted to identify different clinical features and management for the various pediatric age groups.

AIM

To find surgical perspectives for the pediatric age-related variants of OMDR and make recommendations for optimal management.

METHODS

The medical records of pediatric patients diagnosed with OMDR were reviewed retrospectively. Fifteen patients diagnosed based on incidental findings during other surgeries were excluded. The patients were divided into two groups based on age: < 12 mo (infants) and > 12 mo (beyond infancy). We analyzed the demographic characteristics, clinical manifestations, diagnostic tools, surgical procedures, and clinical outcomes of the patients and compared them for the age groups. Chi-squared and Fisher's exact tests were used for nominal scales and a Mann-Whitney test was used for ratio scales.

RESULTS

A total of 35 patients (7 infants, 28 children beyond infancy) were finally included. In both groups, Meckel's diverticulum (MD) was the most common type of OMDR, while umbilical lesions were more common in the infant group (P = 0.006). Hematochezia and abdominal pain were common in the beyond infancy group, while umbilical lesions were the most frequent symptoms in the infant group. Several diagnostic tools were used, but Meckel's scan was most useful in diagnosing OMDR in patients with painless rectal bleeding. Minimally invasive surgery was more commonly performed for children than for infants (P = 0.016). Single-incision laparoscopic surgery (SILS) was performed for fifteen patients who underwent laparoscopic surgery. There were only three cases of postoperative complications, and all patients survived in good condition.

CONCLUSION

The clinical type of OMDR varies with age, umbilical lesions in infants, and MD beyond infancy. SILS is effective for managing children with MD regardless of age.

Keywords: Omphalomesenteric duct remnant, Age, Surgical, Meckel's diverticulum, Single-incision laparoscopic surgery, Children

Core Tip: This is a retrospective study aimed at identifying surgical perspectives for variants of the omphalomesenteric duct remnant (OMDR) manifesting in different age groups. Meckel's diverticulum was the most common type of OMDR in all the subjects, while umbilical lesions were more common in the infant group. For management, minimally invasive surgery was more common beyond infancy, and single-incision laparoscopic surgery may be considered the preferred surgical procedure.