Umbilical abnormalities and related anomalies

Dikki Drajat Kusmayadi Division of Pediatric Surgery Hasan Sadikin Hospital Bandung

Umbilical abnormalities and related anomalies

Introduction:

Failure of umbilical cord separation Drainage

Mass

Infection

Umbilical abnormalities and related anomalies

Umbilical abnormalities and related anomalies Introduction

The umbilical cord remnant usually separates in the first month of life, and persistence after the end of the second month of life is considered abnormal.

Umbilical abnormalities and related anomalies

Introduction

Umbilical abnormalities and related anomalies

Introduction

Umbilical abnormalities and related anomalies

Vitelline abnormalities

Neoplasma

Anomalies spectrums
Infection

Urachal abnormalities

Umbilical hernia

Vitelline / Omphalomesenteric duct (OMD) Abnormalities

Resulting from failure of involution of the OMD

Vitelline / Omphalomesenteric duct (OMD) Abnormalities Umbilical granuloma umbilical polyp

Vitelline / Omphalomesenteric duct (OMD) Abnormalities

Tx/ : -granuloma umbilcus
silver nitrate surgical excision may be

Granulation tissue umbilical polyps

necessary. If there is no response after two or three attempts at silver nitrate therapy Pedunculated lesions w/ a narrow stalk : ligation of their base

Vitelline / Omphalomesenteric duct (OMD) Abnormalities

Patent OMD

Patent OMD + Evagination

Vitelline / Omphalomesenteric duct (OMD) Abnormalities Patologic condition:

A fibrous OMD tract ( small bowel-umbilicus): asymptomatic volvulus internal hernia

Meckel Diverticulum : Bleeding

Brick red or maroon blood, painless, and occurs only intermittently. Meckels scan (technetium-99m) is specific for gastric mucosal cells; the accuracy is greater than 90% in children.

MD (Meckel Diverticulum) Obstruction

Possible mechanisms:
1. 2. 3. 4. 5. intussusception internal hernia volvulus around an attached band prolapse OMD, Secondary to an inflammatory process. through a patent

MD (Meckel Diverticulum) Inflammation

Usually present at a later age Often mistaken for appendicitis Result of lumenal obstruction, bacterial invasion, progressive inflammation Ectopic gastric mucosa predisposes
Tx: simple Resection n closure,
,

transverse

Resection with involved

ileum and end to end anastomosis

CT SCAN ; Suspicious for MD

Incidental MD finding
RESECT Vs LEAVE IT ALONE !!! PALPABLE ECTOPIC MUCOSA PROMINENT (FIBROUS)VITELLINE ARTERY REMNANT EVIDENCE OF INFLAMATION A NARROW BASE

Urachal Abnormalities
- The urachus connects the bladder to the allantois.

Symptom :( Snyder, 2007)

1. umbilical drainage (42%), 2. mass or cyst (33%), 3. pain (22%), 4. Urinary symptoms were infrequent (5%).
Infection Malignancy

Urachal Abnormalities

Urachal Abnormalities

Diagnosis
Ultrasound evaluation ( initial screening test) VCUG

Diagnosis
Contrast sinogram/ fistulogram (umbilical drainage ) CT SCAN

Urachal Cyst
Usually asymptomatic until infected Rarely become infected in newborn period, usually manifests as young adult

Infected Urachal cyst

Fever, voiding symptoms, midline hypogastric tenderness, mass, UTI May drain into bladder or umbilicus Rarely can rupture into preperitoneal tissues or peritoneal cavity Cultures - Staph Aureus

Infected Urachal cyst

Tx: Incision and drainage Percutaneous drainage Complete surgical excision of all urachal tissue Staged approach limits amount of bladder resected

Treatment Patent Urachus

Urachal Sinus
Becomes symptomatic when infected Tx drainage and resection of urachal tissue

Urachal Diverticulum

Blind sac at bladder apex Mostly asymptomatic

Malignancy
Have a risk of future cancer. 1% to 10% of adult bladder cancers, with a 10year disease-free survival of about 50%. Although adulthood. malignancy develops in late

Umbilical hernia
Weak or absent of suporting fascia
Richets fascia ; vitelline artery remnant, urachal remnant ;

80% spontanous closure ( defect diameter < 1 cm) 96% w/ defects < 0.5 cm closed spontaneously

Umbilical hernia

Umbilical hernia
Management Observation Surgical closure Indication:
Giant proboscoid hernia ( in the first 2 year) Large defects( >1,5 cm) persist past the age of 5 Incarcerated umbilical hernia

Frequent Issue:
Children w/ small defect undergoing

anesthesia for unrelated problem(eg. Inguinal hernia repair. Do we need to repair ?

Discuss

w/

Parent

but

still

recommend

observation

Infection
Still are a common cause of morbidity and mortality in less developed countries. Umbilical infections in the infant are often related to hygiene issues. Can progress to severe cellulitis or necrotizing fasciitis

Treatment
Broad spectrum antibiotic treatment is provided Surgical debridement may be necessary.

Case Ilustration

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