Umbilical pathology
Key points
Umbilicus: connecting stalk between the placenta and infolding foetus
5 main structures connecting to it:
Allantois + Urachus - obliterates to form median umbilical ligament - pathologic remnant: patent urachus/urachal cyst/urachal sinus
Extracoelomic yolk sac + Vitellointestinal duct - obliterates - pathologic remnants: Meckel's diverticulum/band, patent VI duct
2x umbilical arteries - remnants: Medial umbilical ligaments
1x umbilical vein - remnant: ligamentum teres/falciform
Giant umbilical cords may represent abnormal remnants. Care when clamping cord should be made
Malignancies very rare in relative terms - so routine excision of all remnants not advised
Umbilical granuloma
Should resolve in several weeks
Persistent granulomas can be treated with applications of table salt or silver nitrate
Urachal remnant or patent vitellointestinal duct
Presents with urine or faeculent discharge, or may just be persistent granuloma
Pain and retraction of umbilicus during micturition - symptom of patent urachus
Procedure - Umbilical exploration
Excise granuloma
If tract extending into abdomen - infraumbilical incision and enter peritoneum
Follow tract + excise
If patent VI duct may need to do bowel resection + anastomosis
Infected urachal cyst
Treat with IV antibiotics - if not successful percutaneous drain
Follow up USS - may obliterate and not require excision
If persistent, excise through infra-umbilical incision
Omphalitis
Necrotising fasciitis may result from Omphalitis in developing countries - requires emergency excision of umbilicus
May need to excise umbilical vessels and urachus
Breakdown of umbilicus causes evisceration
Infection of vessels may cause portal venous thrombosis and ascending hepatic sepsis
Page edited by Mrs Charnjit Seehra BSc November 2024
References
Briggs KB, Rentea RM. Patent Urachus. [Updated 2023 Apr 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557723/
Kosloske AM, Bartow SA. Debridement of periumbilical necrotizing fasciitis: importance of excision of the umbilical vessels and urachal remnant. J Pediatr Surg. 1991 Jul;26(7):808-10. doi: 10.1016/0022-3468(91)90144-i. PMID: 1895189.