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November 1997

Picture of the Month

Author Affiliations

From the Departments of Pediatrics, Madigan Army Medical Center, Fort Lewis, Wash (Drs Hinson and Mizelle); Oak Harbor Naval Hospital, Whidbey Island, Wash (Dr Biswas); and the American Board of Pediatrics, Chapel Hill, NC (Dr Tunnessen).

Arch Pediatr Adolesc Med. 1997;151(11):1161-1162. doi:10.1001/archpedi.1997.02170480091015

THE UMBILICAL cord of a 10-hour-old male neonate with tachypnea was transected to place a venous line. Two umbilical arteries and 1 umbilical vein were identified. A fourth lumen was noted in the cord (Figure 1). This lumen was cannulated with an umbilical vessel catheter, but no blood return was present on aspiration. An abdominal radiograph showed that the umbilical catheter was likely in the lumen of the small bowel. After injection of a small amount of water-soluble contrast material through the catheter, the material was identified in the small bowel by an abdominal radiograph (Figure 2).

Denouement and Discussion  Persistent Omphalomesenteric DuctThe omphalomesenteric, or vitelline, duct is a broad stalk by which the embryonic midgut maintains contact with the yolk sac.1 The duct usually involutes by the fifth to ninth week of gestation2; however, a remnant of the omphalomesenteric duct may persist in approximately 2% of

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