Omphalomesenteric Duct Remnant As A Cause Of Small Bowel Obstruction With Incidental Appendiceal Carcinoid: A Case Report

Omphalomesenteric duct remnants are a rare cause of abdominal pain, especially in the adult. Their diagnosis is not straightforward. We report the case of a healthy 25-year-old male presenting with chronic, intermittent abdominal pain over 1 month with no previous abdominal surgeries. Extensive investigations including computed tomography (CT) scan and colonoscopy were non-contributory. Thus a diagnostic laparoscopy was performed, which revealed a fibrous band originating from the anterior abdominal wall at the umbilicus and terminating behind the mid-transverse colon, with cecum and small bowel tethered to it, as well as signs of chronic inflammation in this area. Excision of the band as well as an appendectomy were performed. Histopathology confirmed the specimen to be an omphalomesenteric (vitelline) duct remnant, and also revealed an incidental small carcinoid tumour in the appendix. This case report highlights that undiagnosed abdominal pain with negative investigations needs to be treated with caution to not miss a broader range of diagnoses and that diagnostic laparoscopy is a useful tool. Omphalomesenteric duct remnant is a rare cause of chronic abdominal pain and intermittent obstruction in an adult.