Umbilical cord anomalies: antenatal ultrasound findings and postnatal correlation

Abstract

Umbilical cord anomalies are rare. The differential diagnosis for a cystic structure around the umbilical cord and its insertion include pseudocyst, omphalomesenteric duct cyst, haemangioma, omphalocele or anterior abdominal wall defects. Although cord anomalies can be detected through antenatal ultrasound scans (US), very often a definitive diagnosis cannot be made. This may affect the management of the infant at birth. In cases where antenatal US was not diagnostic, current evidence supports the use of MRI to help in making an accurate diagnosis. We report two cases of umbilical cord anomalies. The first case was diagnosed in antenatal US as an omphalocele, but was found to be an allantoic cyst with hamartoma on postnatal diagnosis. The second case was not detected on antenatal US, and was diagnosed postnatally as a small omphalocele with vitellointestinal duct remnants.

Keywords: gastrointestinal system; materno-fetal medicine; neonatal and paediatric intensive care; paediatric surgery.

Figure 1

Clinical photograph of an umbilical cord cyst over the anterior abdomen of a baby (A–B). A segment of the cord shows cystic distension of the cord (C). Cut section of the cord reveals a central solid grey-white area (D).

Figure 2

Vascular proliferation in close proximity to an umbilical artery (A). A small solid nest of epithelial cells (asterisk) representing an allantoic duct remnant is present adjacent to a collection of thin-walled vessels (B). Scattered nerves (asterisks) are admixed in the vascular proliferation (C).

Figure 3

Meconium stained umbilical cord with intestinal loops and two areas of perforation. Meconium is seen coming out through one of them.

Figure 4

Intraoperative photo showing bowel connected through the vitello intestinal duct (arrow).