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Paediatrics: Umbilical anomalies

Paediatrics: Umbilical anomalies
The commonest umbilical abnormality seen in infants is an umbilical granu-loma.

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.

 

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