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LETTER TO EDITOR |
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| Year : 2007 | Volume
: 12
| Issue : 1 | Page : 60 |
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Authors' reply
R Kale, R Handa, MM Harjai
Army Hospital (Research and Referral), New Delhi - 110 010, India
Correspondence Address:
M M Harjai
Army Hospital (Research and Referral), New Delhi - 110 010
India
 Source of Support: None, Conflict of Interest: None  | Check |
How to cite this article:
Kale R, Handa R, Harjai M M. Authors' reply. J Indian Assoc Pediatr Surg 2007;12:60 |
Sir,
We thank Dr. Raveenthiran for having raised the possibility of the 'perforation' being a patent vitello-intestinal duct in our reported case.[1] Intraoperatively we considered this possibility but the perforation site was mid-ileal and so too proximal to be a patent vitello intestinal duct.
Why did the perforation occur? [Figure 1] in the case report clearly shows a narrow neck of the omphalocele. This produced a vascular ischemia of the bowel within the body and fundus of the omphalocele. The dilated proximal bowel seen in [Figure 2] is consistent with the observation of a narrowing effect at the neck of the omphalocele. Probably the vascular compromise was partial and so resulted in a perforation at the antimesentric border of the ileum. As regards the absence of spillage in the peritoneal cavity. The margins of the perforation were adherent to the omphalocele sac. We know that the development of adhesions following abdominal surgery are due to devitalized segments attempting to obtain a fresh source of blood supply for its survival.
Let us consider the situation the other way. If it was a patent vitello intestinal duct, why is the proximal bowel dilated?
 References | |  |
| 1. | Kale R, Handa R, Harjai MM. Perforated small bowel in omphalocele at birth. J Indian Assoc Pediatr Surg 2006;11:39-40.  |
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