title: Latent vitellointestinal duct sinus presenting with massive lower gastrointestinal bleeding in an adolescent.
abstract: A 12-year-old boy with a history, at birth, of a weeping pink fleshy lesion after his umbilical cord detached, requiring repeated chemical cauterisation, presented with massive lower gastrointestinal bleeding and required resuscitation and blood transfusion. Augmented Tc99m nuclear medicine scan confirmed ectopic gastric mucosa. The lateral view suggested its attachment behind the umbilicus. At exploration, a latent vitellointestinal duct sinus with ectopic gastric mucosal mass was found. Segmental resection of the sinus and mass excision with primary anastomosis and incidental appendicectomy was curative. Pink fleshy mass discharging coloured fluid at the umbilicus following detachment of umbilical cord should be considered a remnant of vitellointestinal duct unless proved otherwise. A pink lesion with yellowish discharge resistant to chemical cauterisation should raise the suspicion of embryonic structures. Latent vitellointestinal sinus is a new lesion in the spectrum of umbilical anomalies. Lateral view of the nuclear medicine scan is helpful in locating the site.
authors.affiliation: Department of Paediatric Surgery, University Hospital of Wales, Cardiff, UK.
authors.forename: Ramnik V
authors.initials: RV
authors.lastname: Patel
authors.affiliation: Department of Paediatric Urology, Great Ormond Street Children Hospital NHS Trust, London, UK.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Evans
authors.affiliation: Department of Paediatric Surgery, Children Hospital of Pittsburgh of UPMC, Pittsburgh, USA.
authors.forename: Indranil
authors.initials: I
authors.lastname: Sau
authors.affiliation: Department of Paediatric Surgical Oncology, University Hospital of Wales, Cardiff, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Huddart
mesh_terms: D002648:Child; D002828:Choristoma / Q000000981:diagnostic imaging / Q000601:surgery; D005753:Gastric Mucosa / Q000000981:diagnostic imaging / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007077:Ileal Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D007412:Intestinal Fistula / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D011877:Radionuclide Imaging; D014472:Umbilicus / Q000000981:diagnostic imaging; D014816:Vitelline Duct / Q000002:abnormalities* / Q000000981:diagnostic imaging* / Q000601:surgery