Umbilical anomalies
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.
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.
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.
•
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.
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