This document discusses various diseases and abnormalities that can affect the umbilicus. It begins by introducing the importance of the umbilicus during fetal development and after birth. There are several sections that describe different conditions in more detail, including inflammation of the umbilicus (omphalitis), umbilical granuloma, fistulas, neoplasms, hernias, and umbilical calculi. Specific abnormalities discussed in more depth include patent vitellointestinal duct, urachal anomalies, umbilical adenoma, and Sister Mary Joseph's nodule, which is a metastatic tumor found in the umbilicus. In general, the document provides an overview of normal umbilical development and the various acquired, infectious

1. Dr Karrar Adil

2. Introduction :
 In utero, the umbilicus is a vital conduit between
the placenta and fetus and directly impacts the
development of the intestine and urinary
systems.
 After delivery its importance diminishes to the
role of a potential site of neonatal vascular
access.
 Disorders of the umbilicus are either acquired,
infectious, neoplastic, or congenital .

3. diseases of the umbilicus :
1- Inflammation :
• Inflammation of the stump of the umbilical cord (omphalitis)
• Umbilical granuloma
• Umbilical dermatitis
• Pilonidal sinus
2- Fistula :
 Faecal:
• Patent vitellointestinal duct
• Neoplastic ulceration from the transverse colon
• Tuberculous peritonitis
 Urinary: Patent urachus

4. 3- Neoplasm :
 Benign:
• Adenoma (raspberry tumour)
• Endometrioma
 Malignant:
• Primary
• Secondary (Sister Joseph's nodule):
(Stomach, Colon, Ovary, uterus, Breast).
4- Hernia
5- Umbilical calculus (umbolith).

5. OMPHALITIS :
 It is infection and inflammation of umbilicus. It
is usually seen in newborn babies.
 Causes : Poor asepsis and umbilical hygiene
during delivery and after birth.
 Umbilical cord which is severed during birth
contains bacteria like staphylococci (50%),
streptococci, E. coli, Clostridium tetani
(occasionally).

6. Features :
 Infection may spread along the hypogastric vessels into the
abdominal wall causing abdominal wall abscess.
 Infection may spread into the peritoneum causing peritonitis.
 In severe cases, septicaemia can occur.
 Umbilical granuloma can occur once infection gets localised.
 Purulent discharge with red, swollen umbilicus.

7. Umbilical granuloma :
 It is due to chronic infection of the umbilical
cicatrix, causing the granulation tissue to
pout, leading to the formation of umbilical
granuloma.
 It occurs 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.
 It has to be differentiated from the anomalies
of vitellointestinal duct. It also mimics
umbilical adenoma.

8. Anomalies of vitellointestinal duct :
 During development of fetus, midgut communicates
with yolk sac through vitellointestinal or
omphalomesenteric duct.
 This duct slowly narrows during the development of
abdominal wall to lie within the cord, later this
communication obliterates to free intestine from
yolk sac.
 Any defect in obliteration causes different
anomalies.

9. Anomalies are :
1- May remain completely
patent, forming an intestinal
fistula.
2- Only a small portion near
the umbilicus may remain
patent forming discharging
umbilical sinus.

10. 3- Duct is closed on either side,
but the intervening portion may
remain as an intra-abdominal
cyst.
4- Vitellointestinal duct which is
obliterated can retain as a band
which may cause intestinal
obstruction (internal herniation).

11. 5- Intestinal end may remain patent forming
Meckel's diverticulum.

12. Patent vitellointestinal duct

13. Umbilical sinus :
Causes :
• Persistent vitellointestinal tract partially towards umbilical side,
Persistent urachus.
• Tuberculosis, Umbilical infection.
• Umbolith.
• Pilonidal sinus of the umbilicus.
• Malignancy in the urachus.
Clinical features :
• Pain.
• Swelling.
• discharge from the umbilicus.
• Features of the specific causes.

14. Umbilical Adenoma (raspberry tumour)
:
 It is commonly seen in infants. It is due
to partially obliterated vitellointestinal
duct towards umbilical end, causing
prolapse of the mucosa giving rise to
umbilical adenoma.
 It protrudes out as a red swelling, which
is moist with mucus and tends to bleed
on touch.
 It often gets infected, discharging pus
through the umbilicus.
 Histologically, it consists of columnar
epithelium rich in goblet cells.

15. Umbolith (umbilical stone) :
 is a periumbilical mass that may form
due to the accumulation of sebum and
keratin.
 The colour is black or brown, and may
be related to the skin type of the patient.
 may resemble a malignant melanoma.
 caused by poor hygiene and may form
in retracted umbilicus of obese people.
 may cause recurrent umbilical infection
and sinus.

16. Patent urachus :
 Allantoic duct/stalk which is remnant of cranial part of ventral
urogenital sinus forms urachus. It gets fibrosed and forms
median umbilical ligament.
 defect in obliteration of urachus causes different anomalies :
 Patent urachus (Urachal fistula) between umbilicus and dome
of the urinary bladder.
 Urachal sinus if only umbilical side of the urachus is patent.
 Urachal cyst if only middle portion of the urachus is patent with
lining and fluid content.
 Urachal diverticulum when bladder side of the urachus is
patent.

18. Sister Mary Joseph nodule :
 palpable nodule bulging into the umbilicus as a
result of metastasis of a malignant cancer in the
pelvis or abdomen.
 Gastrointestinal malignancies account for about
half of underlying sources (gastric, colonic, or
pancreatic cancer).
 Gynecological cancers account for about 1 in 4
cases (ovarian and uterine cancer).
 Proposed mechanisms for the spread of cancer
cells to the umbilicus include direct
transperitoneal spread, via lymphatics,
hematogenous spread, or via remnant
structures such as the falciform ligament,
median umbilical ligament, or a remnant of the
vitelline duct.
 is associated with multiple peritoneal
metastases and a poor prognosis.

19. Thank you
…