Umbilical Granuloma

Umbilical Granuloma

Figure 2.128. Umbilicus amnioticus or amniotic navel ("innie") in an infant at the age of 5 days. This is less common. The amniotic portion of the umbilical cord extends to the abdominal wall and this results in a true belly button.

Figure 2.127. Superior and lateral view of umbilicus cutis in another infant. "Outies" or skin navels are more common in black infants. This protrusion is not reducible in contrast to infants with umbilical herniae. Umbilical herniae arise due to separation of the rectus muscles with herniation of the omentum and, on some occasions, bowel. Umbilical herniae resolve spontaneously as the rectus muscles become stronger, usually by the age of 18 months to 2 years.

Figure 2.128. Umbilicus amnioticus or amniotic navel ("innie") in an infant at the age of 5 days. This is less common. The amniotic portion of the umbilical cord extends to the abdominal wall and this results in a true belly button.

Figure 2.129. Examples of hematoma of the umbilical cord as a result of trauma. These can be a source of significant blood loss if rupture occurs early in the neonatal period.

Figure 2.130. Umbilical granuloma in an infant with umbilicus cutis. This results from overgrowth of granulomatous tissue at the umbilicus when the cord separates. These occur more commonly in infants with large, thick umbilical cords. The tissue may be friable and bleeds easily. This can be treated with silver nitrate cauterization. Infants who have discharge or foul odor at the umbilicus may have umbilical granulomas or a patent omphalomesenteric duct (patent vitellointestinal duct).

Patent Vitello Intestinal DuctPatent Vitello Intestinal Duct

Figure 2.131. Patent omphalomesenteric duct in an infant with stool draining at die umbilicus. During early embryonic life the vitelline duct connects the yolk sac to the primitive bowel. It normally obliterates and atrophies in the course of fetal development. If it persists, it may present as a lumen through which intestinal contents pass from the umbilicus.

Figure 2.131. Patent omphalomesenteric duct in an infant with stool draining at die umbilicus. During early embryonic life the vitelline duct connects the yolk sac to the primitive bowel. It normally obliterates and atrophies in the course of fetal development. If it persists, it may present as a lumen through which intestinal contents pass from the umbilicus.

Patent Urachus Granuloma

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Figure 2.132. This abnormal appearance of an umbilical cord which showed a bright red surface was shown histologically to be a granulomatous omphalomesenteric duct remnant.

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Patent Urachus Granuloma

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Omphalomesenteric Duct Remnant

Figure 2.134. Note drainage of urine from the umbilicus due to a patent urachus. The marked abdominal distention in this infant was associated with absence of the abdominal musculature.

Figure 2.133. Histologic specimen of the same umbilical cord as in Figure 2.132 showing the omphalomesenteric duct remnant. Note the presence of columnar epithelium as seen elsewhere in the intestinal wall.

Figure 2.134. Note drainage of urine from the umbilicus due to a patent urachus. The marked abdominal distention in this infant was associated with absence of the abdominal musculature.

Figure 2.135. Umbilical hernia in a black infant at the age of 3 days. Umbilical herniae arise due to a separation of the rectus muscle with herniation of the omentum and, on some occasions, bowel.

Figure 2.136. Omphaloceles can be quite small in infants and can resemble a Wharton's jelly cyst. The sac may contain a single loop of bowel as noted in this infant. Because of this risk of an omphalocele, the cord should not be cut or clamped close to its insertion.

Figure 2.137. This infant has a moderate-sized omphalocele. The sac may contain a single loop of bowel or most of the intestine and liver. An omphalocele is caused by failure of the complete return of intestines to the abdominal cavity in early fetal life (10 weeks). Extra-abdominal contents are positioned midline. The umbilical cord is incorporated and a sac is present. Intestinal malrotation is a frequent associated finding. Omphaloceles may occur as isolated findings or can be associated with other congenital and chromosomal abnormalities. It is frequently seen in trisomy 13 and in Beckwith-Wiedemann syndrome.

Figure 2.138. Infant with Beckwith-Wiedemann syndrome with an omphalocele. As noted in the preceding photographs of infants with omphaloceles, die defect is covered only by peritoneum widiout overlying skin. Note the many loops of bowel. This thin membranous sac may rupture.

Figure 2.138. Infant with Beckwith-Wiedemann syndrome with an omphalocele. As noted in the preceding photographs of infants with omphaloceles, die defect is covered only by peritoneum widiout overlying skin. Note the many loops of bowel. This thin membranous sac may rupture.

Omphalocele

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What Plum Belly Syndrome Infants

Figure 2.141. This infant with absence of the abdominal musculature (prune belly syndrome) had both an omphalocele and a patent urachus. On the left note the omphalocele with the opening of the urachus in the lower portion. On the right note the omphalocele and drainage of urine from the patent urachus.

Figure 2.139. Lateral radiograph showing the omphalocele with bowel contents in an infant with Beckwith-Wiedemann syndrome.

Figure 2.140. This infant has a giant omphalocele. Note that in addition to bowel the liver is present in the omphalocele and that the overlying membranous sac has ruptured. The incorporation of umbilical cord differentiates this from gastroschisis.

Figure 2.141. This infant with absence of the abdominal musculature (prune belly syndrome) had both an omphalocele and a patent urachus. On the left note the omphalocele with the opening of the urachus in the lower portion. On the right note the omphalocele and drainage of urine from the patent urachus.

Figure 2.142. In gastroschisis there is no covering membrane. Gastroschisis is the result of an anterior abdominal wall defect which is usually paramedian to the right of the umbilical cord insertion. Gastroschisis is rarely associated with other congenital anomalies. There may be an associated intestinal malrotation and occasionally there are atretic portions of the extra-abdominal bowel. The stomach, bowel, and bladder may be outside the abdomen and completely uncovered. Note that the liver is never outside the abdominal cavity in an infant with gastroschisis.

Gastroschisis

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Responses

  • Feorie
    Is an umbilical granuloma considered an abdominal wall defect?
    5 years ago

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