disease of umblicus

1. Disorder of umbilicus
Dr. Rana Pratap Singh
Assistant professor
Gen surgery
Jss medical college

2. The umbilicus
The navel, or umbilicus, is the site of
attachment of the fetal umbilical cord
and is located along the linea alba.

3. • The umbilicus is an inconstant landmark.
• In the healthy adult it lies at the junction of L3 and
L4 vertebrae.
• It is lower in the infant
•It is higher in late pregnancy.

4. • Linea alba is well defined above and
illdefined below
• Supplied by T10
• Segment Porto-caval
anastomosis
•Meeting point of three systems
( vascular , GIT , excretory)

11. Umbilical diseases
congenital
Patent vitello-
intestinal duct
Patent urachus
Hernias
inflammatory
Omphalitis.
Umbilical granuloma.
Pilonidal sinus.
GI fistulas
Neoplastic
Benign
Malignant

12. 1. Exomphalos major and minor
2. Childhood hernias
3. Adult hernias

13. •it is due to partial or complete failure of
return of the midgut into the peritoneum
during development
2 types
• Exomphalos minor
•Exomphalos major
Exomphalos minor has a small sac , cord
attached to the summit , easily reducible ,
treated b strapping for 2 weeks

14. Exomphalos major
 Large defect and a large sac
 Umblical cord is attached
to the inferior aspect
 Emergency treatment
 Primary single staged
repair or 2 staged repair

15. M:F 2:1
Neonatal sepsis is predisposing Factor
Usually amptomatic
Strangulation is a rare complication
Spontaneous closure occurs by 2 yrs
Surgery is indicated if not closed by 4 yrs

16. Umbilical hernias in adults are mostly acquired
Common in women
Predisposing factors are
increased intra-abdominal pressure
pregnancy
obesity
ascites
abdominal distention
single midline aponeurotic decussation
Irreducibility , obstruction , strangulation and
rupture are common complications

17. •Commonly overweight
thinned and attenuated
midline raphe.
•The bulge is typically slightly to
one side of the umbilical depression,
creating a crescent-shaped
appearance to the umbilicus
•Treatment
• Small hernias – observation
• Large hernias - open or
laparoscopic
• Primary repair, mayo’s ,
• mesh repair
• laparoscopy

19. Urachus
• a duct between the bladder and
the yolk sac
- Between the 5th and 7th week
of development, the allantois
will become the urachus
• median umblical ligament – obliterated
urachus

21. Patent urachal
•Manifests in new
born
• One-third associated
with distal urinary
obstruction
•Urine from umblicus
•Giant umblical cord
complete excision
of the tract with a
cuff of bladder

22. Commonest urachal anamoly in
adults
D ue to persistance of the part of
the tract symptoms due to
(asymptomatic)
- size ( mass )
- infection( pain,
fever,urinary symptoms ,
umblical discharge )
- rupture ( peritonitis)

23. Diagnosis by clinical , usg ,
and by cect
Treatment
1) single stage – complete excision of
the tract
2) two stage - I & D
followed by
complete excision after
control of sepsis

24. •Due to persistance of the distal
urachus asymptomatic
unless infected
• Pain, fever , pus discharge
• Diagnosed by Usg ,
sinogram
• Manage by excision of the
sinus tract

25. • Least common
urachal anamoly
Asymptomatic
• Incidental diagnosis cystoscopy ,
mcu , usg
Treatment usually not required

26. Anomalies connected with the vitellointestinal duct.
(a) Umbilical fistula; (b) intra-abdominal cyst; (c) intraperitoneal band;(d) Meckel’s
diverticulum with a band adherent to the sac of a congenital umbilical hernia.

27. • Most common abnormality of the
omphalo- mesenteric duct
• Antimesenteric border
of ileum 50 –200 cms
from ICJ
• True diverticulum
• Mostly asymptomatic
• Lower GI bleed , inflammation ,
obstruction heterotropic mucosa

28.  Asymptomatic
 Abdominal mass
 Umbilical granuloma
 Umbilical discharge (faeces & air )
 GI bleeding
 Intestinal obstruction

29. xray abdomen
USGabdomen
CECT abdomen
99mTc scan

30. segmental resection and reconstruction

31. Infection of the retained umbilical
cord
Poor asepsis and umbilical hygiene
during delivery
Staphylococci, streptococci, Gram-
negative organisms, Clostridium
tetani

32. Abscess
Cellulitis
Gangrene
Peritonotis
Septicemia
Granuloma
Pus discharge

33. Antibiotics
Cauteristaion
Debridement

35. • Chronic infection of the umbilical cicatrix,
Can occur in any age group, but common in
infants and children.
• Presents as umbilical discharge with tender, red,
swelling protruding from the umbilicus which bleeds
on touch.
• Mimics umbilical adenoma.
• Treatment
Antibiotics,
silver nitrate
excision of granuloma
umbilectomy

36. • Commonly seen in infants.
• Due to partially obliterated vitello-intestinal
duct towards umbilical end, causing prolapse of
the mucosa
•Appears as a moist, red swelling bleeds on
touch.
•Secondary infection
•Histologically, it consists of columnar
epithelium rich in goblet cells.

39. most common primary benign tumours were,
•Congenitalpolyps,
•melanotic naevi,
•papillomas,
•fibromas, myxomas,
haemangiomas, and
•epithelial inclusion cysts.

40. Primary Secondary
Primary malignancy is
rare (20%)
Skin , soft tissues ,
embryonic tissue rests
adenocarcinoma is the
common primary
tumour
Metastatic tumors are
the commonest (80%)
stomach, ovary, colon
and pancreas
lymphoma, RCC ,
prostate
mean survival is
approximately 10-12
months

41. Primary secondary