Welcome to International Journal of Anatomy and Research

Type of Article: Original Research

Year: 2016 | Volume 4 | Issue 1 | Page No. 2041-2046

Date of Publication: 29-02-2016

DOI: http://dx.doi.org/10.16965/ijar.2016.143

ORIGIN, COURSE AND ASSOCIATED CONGENITAL ANOMALIES OF TYPE 2 SINGLE UMBILICAL ARTERY: A FETAL ANATOMIC STUDY

Hima Bindu Nalluri *¹, Parimala Sirikonda ², Vasntha Leela ³.

^*1 Associate Professor of Anatomy, Bhaskar Medical College, Hyderabad, Telangana, India.
² Assistant Professor of Anatomy, Bhaskar Medical College, Hyderabad, Telangana, India.
³ Professor of Anatomy, Deccan College Of Medical Sciences, Hyderabad, Telangana, India.

Address: Dr. Hima Bindu Nalluri, Associate Professor of Anatomy, Bhaskar Medical College, Yenkapally, Moinabad, Ranga Reddy, Hyderabad, Telangana 500075, India.
E-Mail: nalluribindu@gmail.com

Abstract

Introduction: Umbilical arteries normally originate from a pair of allantoic arteries. A failure of allantoic vascular system in early fetal life results in substitution by the vitelline vascular system, an inherent safety mechanism. This gives rise to anomalous course and origin of the umbilical artery. In these cases, the umbilical artery originates from the abdominal aorta and continues as a single umbilical artery.
Aim: The aim of this study is to elaborate upon our current understanding about the origin, course and associated anomalies of Type2 single umbilical artery.
Material and Methods: Fifty five foetuses, terminated for severe congenital anomalies over a period of 10 years, were sent to the department of anatomy for academic evaluation of congenital anomalies. All the foetuses were dissected systematically to delineate the abnormalities.
Results: Thirty fetuses had two umbilical arteries with normal course on either side of allantois (urachus) and urinary bladder. Single umbilical artery was observed in 25 cases. Twenty had type 1 single umbilical artery and coursed normally. Five cases had single anomalous origin and course of umbilical artery, which was similar to type 2 single umbilical artery (SUA). After opening the abdominal cavity, the umbilical artery was not seen beside the urachus: instead it coursed posteriorly between the coils of intestine. When it was traced further, its origin was from the abdominal aorta. The aorta was hypoplastic below the origin of the single umbilical artery. All these cases were associated with cardiac, gastro-intestinal, vertebral, renal and limb abnormalities.
Conclusion: Very few cases of this abnormality have been described in literature. Only a few of these cases were diagnosed prenatally as a vitelline artery abnormality: our study will thus help refine prenatal diagnosis and management.
Key words: Single Umbilical Artery, Vitelline Origin Of Umbilical Artery, Vitelline Artery, Type 2 SUA, Congenital Anomalies.

References

1. Blackburn W, Cooley W. Umbilical cord. In: Stevenson, Hall and Goodman (eds.). Human Malformations and related anomalies, New York: Oxford University Press, vol II, pp.1275
2. Kapmeier OF.On sirenoform monsters, with a consideration of the causation and the predominance of the male sex among them.Anat Rec 1927; 34:365
3. Rudd NL, KlimeK ML. Familial caudal dysgenesis: evidence for a major dominant gene. Clin Genet 1990; 38: 170
4. Chaurasia BD. Single umbilical artery with caudal defects in human fetuses. Teratology 1974; 9:287
5. Ronni G, Yaron Z. Type II Single umbilical artery (persistent vitelline artery) in an otherwise normal fetus. Prenatal diagnosis  Nov.2002; Vol 22(11): 1040-1043
6. Gamez F, De Leon-Luis, Bravo C, Pintado, Ruiz Y, Palamo S, Ortiz-Quintana, Prenatal diagnosis of Type II single umbilical artery (persistent vitelline artery) in a normal fetus. Ultrasound Obstet Gynecol. 2013; 41: 592-594
7. Roger E. Stevenson, Judith G. Hall. Human malformations and related anomalies 2nd edition, Oxford university press, United States, 2006; 1463-1465
8. Sadler T.W.Langman’s Medical embryology, 11th edition, Wolters Kluver/Lippincott Williams & Wilkins, New delhi, 2010; 192-193
9. Ballantyne JW.The occurrence of non allontoic or vitelline placenta in the human subject. Trans EdinbObester Soc. 1898; 23:54
10. Stevenson R, Jones KL, Phelan MC, et al. Vscular steal: the pathogenetic mechanism producing sirenomelia and associated defects of the visceral and soft tissues. Paediatrics 1986; 78:451
11. Dantzer V, Leiser R. Placentation In: Eurell JAC, Frappie BL (eds), Dellmann’s Text book of Veterinary histology, 6th edition, Willey Blackwell Ames, IA; 2006:280.
12. Monie W, Khemmani M. Absent and abnormal umbilical arteries. Teratology, April 1973; 7(2): 135-141
13. Hoyme HE, Higgenbottom MC, Jones KL. The vascular pathogenesis of gastroschisis: intra uterine interruption of the omphalo mesenteric artery. J Paediatr1981; 98:228,
14. Loh AHP, Prasad STR, Chew SH, Jacobsen AS.Neonatal intestinal volvulus due to a persistent right vitelline artery.PaediatrSurgInt 2007; 23(4): 373-376
15. Prust F.W, Abouatme J. Vitelline artery causing small bowel obstruction in the adult. Surgery 1969; 65:716.
16. Postoloff AV. Intestinal obstruction due to persistence of the omphalomesenteric artery. Ann Surg 1946; 123: 315-320.

Hima Bindu Nalluri, Parimala Sirikonda, Vasntha Leela. ORIGIN, COURSE AND ASSOCIATED CONGENITAL ANOMALIES OF TYPE 2 SINGLE UMBILICAL ARTERY: A FETAL ANATOMIC STUDY. Int J Anat Res 2016;4(1):2041-2046. DOI: 10.16965/ijar.2016.143