Recognising serious umbilical cord anomalies

Abstract

Umbilical vessel catheterisation is a common intervention in neonatal care. Many complications are recognised, some of which are life-threatening. We report the case of a term neonate who was compromised at birth following antepartum haemorrhage with evidence of multiorgan ischaemic injury. Following resuscitation and umbilical vessel catheterisation, she developed pneumoperitoneum. At laparotomy, a patent vitellointestinal duct was identified and resected. Intestinal perforation was found in the duct wall, most plausibly explained by the unintentional catheterisation of the duct via the umbilicus. Learning to recognise umbilical cord anomalies, such as patent vitellointestinal duct, can be simple and could prevent potentially serious complications.

Figure 1

Plain X-ray to confirm the position of umbilical venous catheter. Rigler's (double wall) sign was later noted in the left iliac fossa (arrow).

Figure 2

Eight hours after umbilical catheterisation, significant pneumoperitoneum was present, including air visible under the diaphragm (arrow).

Figure 3

On day 5, mottled changes were seen in the right upper quadrant (arrow), suggestive of necrotising enterocolitis.