Omphalomesenteric Duct Polyp

A 37-year-old man presented with a reddish nodule in the umbilical area that had been present since early infancy. The lesion had been cauterized with silver nitrate several times in the past but had not resolved. No drainage or secondary infection was noted, and the patient was otherwise in good health.

Physical examination of the umbilical area revealed a bright red 8-mm polyp with a sticky surface. No opening was found at the apex of the polyp, and abdominal ultrasonography was normal. The polyp was excised and the base was electrodesiccated. Histologic examination of the polyp showed columnar epithelium characteristic of colonic mucosa.

An omphalomesenteric duct polyp, an infrequent condition present at birth or in early infancy, consists of umbilical remnants of ectopic gastrointestinal mucosa resulting from incomplete closure of the omphalomesenteric duct. In fetal life, this duct communicates between the mid-gut and the yolk sac of the embryo. The duct normally involutes and disappears during the seventh week of embryonic life. Its persistence may result in:

• A completely patent omphalomesenteric duct (umbilical enteric fistula).
• A partially patent omphalomesenteric duct (an umbilical sinus will result if the peripheral portion is involved; a vitelline cyst, if the intermediate portion is involved; and a Meckel diverticulum, if the enteric portion is involved).
• A mucosal remnant at the umbilicus (umbilical polyp).
• A congenital band (obliterated omphalomesenteric duct).

An umbilical polyp warrants investigation for signs of a sinus or fistula. Insertion of a probe or radiologic procedures using contrast medium can help distinguish one from the other. If there is no fistula or sinus, surgical excision of the omphalomesenteric duct polyp is usually adequate.