RELATED UMBILICAL DISORDERS

Department of surgerySonghkla hospital

The development of the anterior abdominal wall • the yolk sac is divided into an intracoelomic portion and an

extracoelomic portion. • The intracoelomic portion becomes the primitive alimentary

canal and communicates with the extracoelomic portion through the vitelline duct, (omphalomesenteric duct).

• This communication is lost at 5-7 wks' gestation. Persistence of part or all of this connection results in omphalomesenteric anomalies.

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1. Omphalomesenteric duct• This is extremely rare and may be recognized with fecal

drainage noted from the umbilicus. It is more common in boys than in girls, and differentiation from urachal anomalies is important for the surgical approach. Confirmation is done through a fistulogram.

2. Partially patent omphalomesenteric duct.• Omphalomesenteric duct sinus• Omphalomesenteric duct cyst• This can be diagnosed with fistulograms and require excision.

3. Meckel's diverticulum.• Persistence of the proximal portion of the omphalomesenteric

duct as a diverticulum opening into the ileum is called a Meckel's diverticulum. It may be associated with an umbilical polyp.

4. Umbilical polyp.• Persistence of intestinal mucosa at the umbilicus can develop

into an umbilical polyp. Probing and possibly a fistulogram are important.

• A simple polyp can be treated superficially with silver nitrate or local excision. It is important, however, to make sure that it is not associated with a duct remnant.

6. Umbilical hernia.•

This is usually congenital and relates to the incomplete closure of the anterior abdominal wall fascia after the intestines have returned to the abdominal cavity.

7.Umbilical granuloma

An umbilical granuloma is a piece of tissue that remains on your baby's belly button after the umbilical cord falls off.treatment• silver nitrate • Liquid nitrogen• Ligation at the base of granuloma • excision

8. Omphalitis• Inflammation of the umbilicus• In full-term infants, the mean age at onset is 5-9 days. In

preterm infants, the mean age at onset is 3-5 days.• Approximately ¾ of omphalitis cases are polymicrobial in

origin. predominated by• Staphylococcus aureus• group A Streptococcus• Escherichia coli• Klebsiella pneumoniae• Proteus mirabilis