É descrito o caso de um adolescente masculino de 14 anos de idade com antecedentes de dor abdominal recorrente e dois episódios “sub- oclusivos” prévios. Recorreu às urgências com dor abdominal e vómitos. Ao exame objetivo, era evidente distensão abdominal e sinais de irritação peritoneal. A radiografia abdominal simples de pé sugeriu a presença de obstrução do íleo distal. Foi realizada uma laparoscopia exploratória, que evidenciou uma estrutura tubular a ligar o bordo antimesentérico do íleo terminal ao umbigo e se comportava como eixo de rotação. Foi efetuada de-rotação do vólvulo e excisão da estrutura. O exame histológico confirmou o diagnóstico de ducto onfalomesentérico persistente. O presente caso ilustra uma obstrução intestinal causada por vólvulo do íleo distal, sendo necessário um alto índice de suspeição para reconhecer esta etiologia.

This report describes the case of a 14-year-old male with a prior history of recurrent abdominal pain and two previous ”sub-occlusive” episodes. He presented at the Emergency Room with abdominal pain, emesis, abdominal distension, painful palpation, and signs of peritoneal irritation. Plain upright abdominal radiography suggested a distal small bowel obstruction. Exploratory laparoscopy showed a tubular structure connecting the antimesenteric border of the terminal ileum and the umbilicus, which was behaving as a rotation axis to the small intestine. The volvulus was laparoscopically de-rotated, and the structure was excised. Histological exam confirmed the diagnosis of persistent omphalomesenteric duct. This case illustrates an intestinal obstruction caused by small intestine volvulus. A high index of suspicion is required to acknowledge this etiology.

A persistência do ducto onfalomesentérico pode ser responsável pela formação de um volvo intestinal na porção do intestino delgado, uma causa rara de abdómen agudo em crianças. Uma criança de quatro anos de idade foi admitida no Serviço de Urgência por dor abdominal e vómitos incoercíveis, sem defesa abdominal nem alterações significativas nos exames auxiliares de diagnóstico. Devido a um agravamento clínico significativo no período de 48 horas em que esteve sob observação, foi transferida para um hospital terciário, com acesso a cirurgia pediátrica. Uma nova avaliação ecográfica abdominal, que demonstrou extensa distensão abdominal e presença de líquido livre, levou a exploração cirúrgica, tendo sido identificado e removido um volumoso quisto do canal onfalomesentérico. Quando sintomática, a orientação terapêutica desta patologia é consensual, consistindo na excisão cirúrgica do defeito anatómico, que foi efetuada. Conclusão: A persistência do ducto do canal onfalomesentérico é uma condição rara, cujo diagnóstico exige um elevado nível de suspeição, sendo muitas vezes detetado apenas durante a cirurgia. A taxa de complicações e mortalidade é elevada e uma intervenção atempada é essencial, dado que a remoção cirúrgica constitui a única opção de tratamento.

A persistent omphalomesenteric duct is one possible cause of small-bowel volvulus, a rare cause of acute abdomen in children. A four-year-old child was admitted to the Emergency Department with abdominal pain and incoercible vomiting, with neither abdominal guarding nor relevant abnormalities revealed in complementary diagnostic exams. Due to a significant clinical deterioration over a 48-hour observation period, the child was transferred to a tertiary hospital with pediatric surgery. An abdominal ultrasound revealing severe bowel distension and increased abdominal free fluid warranted an exploratory surgery, which identified a voluminous omphalomesenteric duct cyst. When symptomatic, treatment of this condition is consensual and consists of surgical excision of the anatomical abnormality, either by laparoscopy or conventional surgery. The latter was performed. Conclusion: A persistent omphalomesenteric duct is a rare condition that generally requires a high level of clinical suspicion for diagnosis to be made, being most commonly detected during surgery. Associated complications and mortality rates are high, and a timely intervention is key, since surgical removal is the only treatment option.

AIM: The main objective of this study was to evaluate the association between prematurity and the time to achieve full enteral feeding in newborns with gastroschisis. The second objective was to analyze the associations between length of hospital stay and time to achieve full enteral feeding with mode of delivery, birth weight and surgical procedure. METHODS: The medical records of newborns with gastroschisis treated between 1997 and 2007 were reviewed. Two groups were considered: those delivered before 37 weeks (group A) and those delivered after 37 weeks (group B). The variables of gestational age, mode of delivery, birth weight, time to achieve full enteral feeding, length of hospital stay and surgical approach were analyzed and compared between groups. RESULTS: Forty-one patients were studied. In Group A, there were 14 patients with a mean birth weight (BW) of 2300 g (range=1680-3000) and a mean gestational age (GA) of 36 weeks (range=34-36). In group B, there were 24 patients with a mean BW of 2700 g (range=1500-3550) and a mean GA of 38 weeks (range=37-39). The mean time to achieve full enteral feeding was 30.1±6.7 days in group A and 17.0±2.5 days in group B (p=0.09) with an OR of 0.82 and a 95% CI of 0.20-3.23 after adjustment for sepsis and BW. No statistical difference was found between low BW (<2500 g), mode of delivery and number of days to achieve full enteral feeding (p=0.34 and p=0.13, respectively). Patients with BW over 2500 g had fewer days in the hospital (22.9±3.1 vs. 35.7±5.7 days; p=0.06). CONCLUSION: The results of this study do not support the idea of anticipating the delivery of fetuses with gastroschisis in order to achieve full enteral feeding earlier.