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Umbilicus is a scar 
Usually located at the level of L3 – L4 
linea alba is well defined above and illdefined 
below 
line...
Umbilical diseases 
congenital 
Patent vitello-intestinal 
duct 
Patent urachus 
Hernias 
inflammatory 
Omphalitis. 
Umbil...
Three types 
1. Exomphalos major and minor 
2. Childhood hernias 
3. adult hernias
it is due to partial or complete failure of 
return of the midgut into the peritoneum 
during development 
2 types 
exomph...
Exomphalos major 
 large defect and a large sac 
 umblical cord is attached to 
the inferior aspect 
 emergency treatme...
common in Africa , M:F 2:1 
neonatal sepsis is a predisposing factor 
usually amptomatic 
strangulation is a rare complica...
Umbilical hernias in adults are mostly acquired 
common in women 
Predisposing factors are 
increased intra-abdominal pres...
commonly overweight 
thinned and attenuated 
midline raphe. 
The bulge is typically slightly 
to one side of 
the umbilica...
Greek : allanto-sausage, 
eidos - shape or similarity 
an endodermal evagination of the 
developing hindgut 
removes nitro...
Urachus – a duct between the bladder and 
the yolk sac 
- Between the 5th and 7th week 
of development, the allantois 
wil...
manifests in new 
born 
one-third 
associated with distal 
urinary obstruction 
urine from umblicus 
giant umblical cord 
...
commonest urachal anamoly in adults 
Due to persistance of the part of the tract 
symptoms due to (asymptomatic) 
- size (...
diagnosis by clinical , usg , cect 
treatment 
1) single stage – complete excision of 
the tract 
2) two stage - I & D 
fo...
Due to persistance of the distal urachus 
asymptomatic unless infected 
pain, fever , pus discharge 
Usg , sinogram 
excis...
least common urachal anamoly 
asymptomatic 
incidental diagnosis cystoscopy , mcu , usg 
treatment usually not required
Most common abnormality of the omphalo-mesenteric 
duct 
antimesenteric border of ileum 
50 – 200 cms from ICJ 
true diver...
asymptomatic 
abdominal mass 
Umbilical granuloma 
umbilical discharge (faeces & air ) 
GI bleeding 
intestinal obstructio...
xray abdomen 
USG abdomen 
CECT abdomen 
99mTc scan
segmental resection and reconstruction
Infection of the retained umbilical cord 
Poor asepsis and umbilical hygiene during 
delivery 
Staphylococci, streptococci...
Abscess 
Cellulitis 
Gangrene 
Peritonotis 
Septicemia 
Granuloma 
Pus discharge
Antibiotics 
Cauteristaion 
Debridement
chronic infection of the umbilical cicatrix, 
Can occur in any age group, but common in 
infants and children. 
Presents a...
commonly seen in infants. 
due to partially obliterated vitello-intestinal 
duct towards umbilical end, causing prolapse 
...
most common primary benign tumours were, 
papillomas, 
Congenitalpolyps, 
melanotic naevi, 
fibromas, 
myxomas, 
haemangio...
Primary malignancy is 
rare (20%) 
Skin , soft tissues , 
embryonic tissue rests 
adenocarcinoma is the 
common primary 
t...
Primary secondary
diseases of Umbilicus
diseases of Umbilicus
diseases of Umbilicus
diseases of Umbilicus
diseases of Umbilicus
diseases of Umbilicus
diseases of Umbilicus
diseases of Umbilicus
diseases of Umbilicus
diseases of Umbilicus
diseases of Umbilicus
diseases of Umbilicus
diseases of Umbilicus
diseases of Umbilicus
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diseases of Umbilicus

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diseases of umbilicus

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diseases of Umbilicus

  1. 1. Umbilicus is a scar Usually located at the level of L3 – L4 linea alba is well defined above and illdefined below line of water shed supplied by T10 segment Porto-caval anastomosis Meeting point of three systems ( vascular , GIT , excretory)
  2. 2. Umbilical diseases congenital Patent vitello-intestinal duct Patent urachus Hernias inflammatory Omphalitis. Umbilical granuloma. Pilonidal sinus. GI fistulas Neoplastic Benign Malignant
  3. 3. Three types 1. Exomphalos major and minor 2. Childhood hernias 3. adult hernias
  4. 4. 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
  5. 5. 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
  6. 6. common in Africa , M:F 2:1 neonatal sepsis is a predisposing factor usually amptomatic strangulation is a rare complication spontaneous closure occurs by 2 yrs surgery is indicated if not closed by 5 yrs
  7. 7. 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
  8. 8. 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 repair primary repair, mayo’s , mesh , laparoscopy
  9. 9. Greek : allanto-sausage, eidos - shape or similarity an endodermal evagination of the developing hindgut removes nitrogenous waste from the fetal bladder allantois is vestigial in humans
  10. 10. 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
  11. 11. 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
  12. 12. commonest urachal anamoly in adults Due to persistance of the part of the tract symptoms due to (asymptomatic) - size ( mass ) - infection( pain, fever, urinary symptoms , umblical discharge ) - rupture ( peritonitis)
  13. 13. diagnosis by clinical , usg , cect treatment 1) single stage – complete excision of the tract 2) two stage - I & D followed by complete excision after control of sepsis
  14. 14. Due to persistance of the distal urachus asymptomatic unless infected pain, fever , pus discharge Usg , sinogram excision of the sinus tract
  15. 15. least common urachal anamoly asymptomatic incidental diagnosis cystoscopy , mcu , usg treatment usually not required
  16. 16. 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 m99Tc scan Resection and reconstruction
  17. 17. asymptomatic abdominal mass Umbilical granuloma umbilical discharge (faeces & air ) GI bleeding intestinal obstruction
  18. 18. xray abdomen USG abdomen CECT abdomen 99mTc scan
  19. 19. segmental resection and reconstruction
  20. 20. Infection of the retained umbilical cord Poor asepsis and umbilical hygiene during delivery Staphylococci, streptococci, Gram-negative organisms, Clostridium tetani
  21. 21. Abscess Cellulitis Gangrene Peritonotis Septicemia Granuloma Pus discharge
  22. 22. Antibiotics Cauteristaion Debridement
  23. 23. 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
  24. 24. 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.
  25. 25. most common primary benign tumours were, papillomas, Congenitalpolyps, melanotic naevi, fibromas, myxomas, haemangiomas, and epithelial inclusion cysts.
  26. 26. 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 Primary Secondary
  27. 27. Primary secondary

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