SURPRISING IDENTIFICATION OF MECKEL'S DIVERTICULUM WITHIN A FETAL OMPHALOCELE DURING PRENATAL CARE

Abstract

Omphalocele is a rare congenital abdominal wall defect that results in herniation of bowels, stomach, and even liver for inside the umbilical cord. Herein we present a case of a Meckel's diverticulum (MD) which was unexpectedly identified inside an omphalocele of a fetus. The mother was a 25-year-old pregnant woman referred due to a fetal omphalocele, which was first visualized at 16 weeks of gestation. On ultrasonography at 21 weeks and 6 days, there was an apparently abnormal circular-shaped image inside the umbilical cord, suggestive of an omphalocele. Fetal MRI confirmed this diagnosis and revealed that some small intestine segments, and portions of mesentery and transverse colon were in an extra-abdominal situation. Moreover, a hyperintense image in T1 and T2 sequences, measuring about 3.9 x 3.8 x 3.6cm, was observed inside the omphalocele, which was compatible with a MD. The child was born by cesarean section, at 40 weeks gestation, weighing 4,030g. The omphalocele was surgically closed, with resection of the MD followed by a terminoterminal anastomosis of the ileum, on the second day of life. The pathology was also compatible with the diagnosis of MD. This report highlights the importance of the proper determination of the omphalocele content still during the prenatal period, since this may present unexpected abnormalities, such as a MD, and thus modify the gestational management as well as birth planning and postnatal care.