Congenital ileal-mesenteric fibrous band remnant of the vitelline artery causing small bowel obstruction in an adult female: a case report

Abstract

The vitelline circulation connects the fetus and yolk sac in the first few weeks of fetal development. Its components are the vitelline duct, vitelline arteries and vitelline vein. This gradually breaks down as the placenta grows and overtakes the function of yolk sac as the primary nutrition source. In the event of persistence of these structures, multiple anatomical anomalies can arise such as a Meckel´s diverticulum, fibrous bands and others. We report on a rare finding of an ileal-mesenteric fibrous band remnant of a vitelline artery causing small bowel obstruction in an adult female. Our patient, a 40-year-old female presented with both clinical and radiological signs of small bowel obstruction. She had had no previous abdominal surgery or abdominal trauma. Intraoperatively we found an isolated ileal-mesenteric fibrous band situated at approximately 7 cm from the ileocecal junction. It spanned from the antimesenteric border of the terminal ileum to the border of the mesentery at a 15 cm breadth. In the snare-like loop that was created, part of the small bowel was trapped, creating a strangulated internal hernia which presented as a small bowel obstruction. The fibrous band was transected and the viable small bowel was freed during a laparotomy procedure. The post-operative period was uneventful and the patient was discharged on day 5. A fibrous band should be considered one of the rare causes of small bowel obstruction in a virgin abdomen in adults.