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
Hinson RM, Biswas A, Mizelle KM, Tunnessen WW. Picture of the Month. Arch Pediatr Adolesc Med. 1997;151(11):1161-1162. doi:10.1001/archpedi.1997.02170480091015