Congenital Adhesions (Differential Diagnosis ´Surgical Abdomen´)

abdo_29a_n.jpg and abdo_29b_n.jpg: Operative findings in a patient with an intestinal obstruction due to adhesions without a visible scar of the abdominal wall. The 1-year-old boy had signs of 'surgical abdomen' and of obstructive ileus. abdo_29a_n.jpg: Operative findings with view of a cord behind which a constricted intestinal loop is recognizable. abdo_29b_n.jpg: Additional view of an antimesenteric appendage which continues in the cord. abdo_29a_n.jpg and abdo_29b_n.jpg: The diagnosis is remnants of an omphalomesenteric (vitelline) duct. In figure abdo_29b_n.jpg a small Meckel's diverticulum is visible which continues in a cord running to the inner side of the navel. This cord compresses the intestinal segment in abdo_29b_n.jpg to a lesser degree (the loop was reduced in the meantime) than in abdo_29a_n.jpg where the loop behind it is almost totally constricted. Residues of the omphalomesenteric duct are frequent causes of congenital adhesions. Abnormal cords of fibrous tissue in disorders of intestinal rotation and fixation also belong to this disease entity, e.g. Ladd's bands. In contrast to the more frequent postoperative obstructions due to adhesions, a former laparotomy and, therefore, an abdominal scar is missing.