Patent Persistent Omphalomesenteric Duct

A 1-week-old full-term baby boy was brought back to the hospital for evaluation of discharge from his navel. Physical examination showed a growth of pink tissue at the umbilicus that seeped yellow liquid (Panel A), which was thought to be mucosal discharge leaking from a patent persistent omphalomesenteric duct. The diagnosis was confirmed by abdominal ultrasonography, which showed a tubular tract measuring 3 mm wide that was connecting the umbilicus to the intestines. No bowel malrotation or obstruction was seen. A persistent omphalomesenteric duct is a congenital anomaly in which the embryonic connection between the yolk sac and midgut fails to regress. It manifests as an umbilical fistula, cyst, or polyp with mucosal discharge if patent. It can be associated with other congenital anomalies or manifest as an isolated anomaly, as in this case. Owing to the baby’s low (first-percentile) birth weight, which was not thought to be associated with the persistent omphalomesenteric duct, surgery was delayed until the baby had gained weight at 1 month of age. Resection of the duct (Panel B, arrow) and involved loop of bowel (Panel B, asterisk) was performed. At the junction of the skin and intestinal loop, ectopic tissue with Brunner-type glands was identified. At the 3-month follow-up, the baby was feeding and growing well.
Pierre-Louis Verot, M.D., and Pierre-Yves Rabattu, M.D., Ph.D.
Published November 5, 2025
N Engl J Med 2025;393:1843
DOI: 10.1056/NEJMicm2509050
VOL. 393 NO. 18


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