RELATED UMBILICALDISORDERSDepartment of surgerySonghkla hospital
The development of the anteriorabdominal wall• the yolk sac is divided into an intracoelomic portion and anextracoelomic portion.• The intracoelomic portion becomes the primitive alimentarycanal and communicates with the extracoelomic portionthrough the vitelline duct, (omphalomesenteric duct).• This communication is lost at 5-7 wks gestation. Persistenceof part or all of this connection results in omphalomesentericanomalies.
1. Omphalomesenteric duct• This is extremely rare and may be recognized with fecaldrainage noted from the umbilicus. It is more common in boysthan in girls, and differentiation from urachal anomalies isimportant for the surgical approach. Confirmation is donethrough a fistulogram.
2. Partially patentomphalomesenteric duct.• Omphalomesenteric duct sinus• Omphalomesenteric duct cyst• This can be diagnosed with fistulograms and require excision.
3. Meckels diverticulum.• Persistence of the proximal portion of the omphalomesentericduct as a diverticulum opening into the ileum is called aMeckels diverticulum. It may be associated with an umbilicalpolyp.
4. Umbilical polyp.• Persistence of intestinal mucosa at the umbilicus can developinto an umbilical polyp. Probing and possibly a fistulogram areimportant.• A simple polyp can be treated superficially with silver nitrateor local excision. It is important, however, to make sure that itis not associated with a duct remnant.
6. Umbilical hernia.•This is usually congenital and relates to the incomplete closureof the anterior abdominal wall fascia after the intestines havereturned to the abdominal cavity.
7.Umbilical granulomaAn umbilical granuloma is a piece of tissue that remains on yourbabys 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. Inpreterm infants, the mean age at onset is 3-5 days.• Approximately ¾ of omphalitis cases are polymicrobial inorigin. predominated by• Staphylococcus aureus• group A Streptococcus• Escherichia coli• Klebsiella pneumoniae• Proteus mirabilis