Patent Omphalomesenteric Duct Arising from the Caecum and Opening at the Umbilicus in a Newborn: A Case Report and Literature Review.

This case report describes a patent omphalomesenteric duct (POD) connecting the umbilicus to the caecum, rather than the classically described umbilicus-to-ileum configuration. A 10-day-old neonate presented to the emergency department with faecal discharge from the umbilical opening. Contrast fistulography through the umbilical orifice demonstrated that the patent tract communicated with the caecum. This preoperative imaging was particularly valuable, as it directly informed the surgical approach. Rather than using a standard periumbilical or lower midline incision, the surgeons performed a right-sided infraumbilical incision extending toward the right lower quadrant, which shortened operative time and facilitated the procedure technically. The tubular tract was resected and the caecal defect primarily repaired. The neonate recovered uneventfully and was discharged on the fifth postoperative day without complications. This case highlights two key clinical points. First, the anatomy of a patent omphalomesenteric duct may not always follow the classic umbilicus-to-ileum pattern, and preoperative imaging is essential for accurate delineation of the tract before surgery. Second, surgical intervention should be considered for all patients with POD, given the well-documented risk of future complications, particularly intestinal obstruction. This report adds a novel anatomical variant to the existing literature and demonstrates how preoperative imaging can guide tailored surgical management in neonatal POD cases, ultimately improving outcomes and reducing operative morbidity in this rare but clinically significant congenital condition.