Incarcerated Persistent Vitelline Duct in a Paraumbilical Hernia: An Uncommon Cause of Bowel Obstruction in an Adult

Case Report

Abstract

Persistent vitelline duct (VD) is a rare embryologic anomaly that occurs when the VD fails to regress completely during fetal development, leading to potential complications such as Meckel’s diverticulum, omphalomesenteric fistula, and bowel obstruction. Although most cases are diagnosed in childhood, adult presentations are extremely uncommon and pose significant diagnostic challenges. This report describes the case of a 50-year-old male who presented with acute abdominal pain, distension, and a lump at the umbilicus. The abdominal X-ray showed features of intestinal obstruction while the ultrasound revealed a small paraumbilical hernia, Had no clue of a persistent VD. Due to the features of bowel obstruction, exploratory laparotomy was done. Intraoperatively, a persistent VD was discovered as a fibrous, tubular structure extending from the ileum to the umbilicus, incarcerated within the hernia sac and causing partial bowel obstruction. The VD was excised with a segment of ileum, and the hernia was repaired. Histopathological examination confirmed the presence of the persistent VD, with no evidence of malignancy. This case emphasizes the rarity of persistent VD in adults and underscores the limitations of ultrasound in detecting such anomalies. It also highlights the importance of maintaining a high index of clinical suspicion even in adult patients with abdominal complaints, particularly those involving paraumbilical hernias and bowel obstruction. Timely surgical intervention can lead to favorable outcomes, as demonstrated in this case. This report contributes to the growing body of literature on adult presentations of persistent VD and provides insights into its diagnosis and management in complex clinical scenarios.