Paediatrics: Umbilical anomalies

Umbilical anomalies

Granuloma

The commonest umbilical abnormality seen in infants is an umbilical granu-loma (see Fig. 23.19). This is a harmless reaction to the resolving umbilical stump and usually disappears by the 2nd to 3rd week.

Treatment

A persistent granuloma should be cauterized with a silver nitrate stick. Vaseline should be applied round the umbilicus to prevent damage to the surrounding skin and a small dressing placed over the umbilicus to prevent marking of the baby’s vest. Multiple applications may be necessary.

Caution A persistent ‘granuloma’ discharging small bowel contents signifies a patent vitello-intestinal duct (Fig. 23.19). Treatment involves surgical exploration of the umbilicus and excision of the duct with a small segment of ileum. The diagnosis is clinical.

Urachal remnants

These are uncommon anomalies that present in infancy or early child-hood. The urachus is an embryonic tubular connection between the blad-der and the allantois that normally obliterates before birth.

•   Main symptom: persistent discharge of urine from the umbilicus.

•   Bladder outlet obstruction (posterior urethral valves) should be excluded by micturating cystography. Treatment is surgical closure.

Umbilical hernias (Fig. 23.19)

•   Common, particularly in Afro-Caribbean children.

•   Most will close spontaneously during the first few years of life, regardless of size.

•   Complications are rare.

If the hernia fails to close surgical repair can be performed at around 5yrs of age.