Umbilicus

Umbilicus is a scar Usually located at the level of L3 – L4 linea alba is well defined above and

illdefined below line of water shed supplied by T10 segment Porto-caval anastomosis Meeting point of three systems ( vascular ,

GIT , excretory)

Anatomy

Umbilical diseases

congenital

Patent vitello- intestinal ductPatent urachus Hernias

inflammatory

Omphalitis. Umbilical granuloma.

Pilonidal sinus.GI fistulas

Neoplastic

Benign Malignant

Diseases of umbilicus

Three types1. Exomphalos major and minor 2. Childhood hernias 3. adult hernias

Umbilical hernias

it is due to partial or complete failure of return of the midgut into the peritoneum during development

2 types exomphalos minor exomphalos major exomphalos minor has a small sac , cord

attached to the summit , easily reducible , treated b strapping for 2 weeks

Congenital type

Exomphalos major large defect and a large sac umblical cord is attached to

the inferior aspect emergency treatment primary single staged repair

or 2 staged repair

common in Africa , M:F 2:1 neonatal sepsis is a predisposing factor usually amptomatic strangulation is a rare complication spontaneous closure occurs by 2 yrs surgery is indicated if not closed by 5 yrs

Umblical hernia in children

Umbilical hernias in adults are mostly acquired common in women Predisposing factors are

increased intra-abdominal pressure pregnancy obesity ascites abdominal distention single midline aponeurotic decussation Irreducibility , obstruction , strangulation and

rupture are common complications

Umblical hernia in adults

commonly overweight thinned and attenuated midline

raphe. The bulge is typically slightly to

one side of the umbilical depression, creating

a crescent-shaped appearance to the umbilicus

Treatment Small hernias – observation Large hernias - open or

laparoscopic repair primary repair, mayo’s , mesh ,

laparoscopy

Patent urachus

 Greek : allanto-sausage, eidos - shape or similarity an endodermal evagination of the

developing hindgut removes nitrogenous waste from the fetal

bladder allantois is vestigial in humans

Allantois

Urachus – a duct between the bladder and

the yolk sac - Between the 5th and 7th week of development, the allantois will become the urachus

median umblical ligament – obliterated urachus

manifests in new born

one-third associated with distal urinary obstruction

urine from umblicus giant umblical cord complete excision

of the tract with a cuff of bladder

Patent urachus

commonest urachal anamoly in adults Due to persistance of the part of the tract symptoms due to (asymptomatic) - size ( mass ) - infection( pain, fever, urinary symptoms , umblical discharge ) - rupture ( peritonitis)

Urachal cyst

diagnosis by clinical , usg , cect treatment

1) single stage – complete excision of the tract 2) two stage - I & D followed by complete excision after control of sepsis

Due to persistance of the distal urachus asymptomatic unless infected pain, fever , pus discharge Usg , sinogram excision of the sinus tract

Urachal sinus

least common urachal anamoly asymptomatic incidental diagnosis cystoscopy , mcu , usg treatment usually not required

Vesico-urachal diverticulum

Patent omphalo-mesenteric duct

Most common abnormality of the omphalo-mesenteric duct

antimesenteric border of ileum 50 – 200 cms from ICJ true diverticulum mostly asymptomatic lower GI bleed , inflammation , obstruction heterotropic mucosa m99Tc scan Resection and reconstruction

Meckel’s diverticulum

asymptomatic abdominal mass Umbilical granuloma umbilical discharge (faeces & air ) GI bleeding intestinal obstruction

Clinical features

xray abdomen USG abdomen CECT abdomen 99mTc scan

Investigations

segmental resection and reconstruction

Treatment

Infection of the retained umbilical cord

Poor asepsis and umbilical hygiene during delivery

Staphylococci, streptococci, Gram-negative organisms, Clostridium tetani

OMPHALITIS

Abscess Cellulitis Gangrene Peritonotis Septicemia Granuloma Pus discharge

Clinical features

Antibiotics Cauteristaion Debridement

Treatment

UMBILICAL GRANULOMA

chronic infection of the umbilical cicatrix, Can occur 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.

mimics umbilical adenoma.Treatment Antibiotics, silver nitrate excision of granuloma umbilectomy

UMBILICAL GRANULOMA

commonly seen in infants. due to partially obliterated vitello-intestinal

duct towards umbilical end, causing prolapse of the mucosa

Appears as a moist, red swelling bleeds on touch.

Secondary infection Histologically, it consists of columnar

epithelium rich in goblet cells.

UMBILICAL ADENOMA (Raspberry Tumour)

Malignancies

most common primary benign tumours were, papillomas, Congenitalpolyps, melanotic naevi, fibromas, myxomas, haemangiomas, and epithelial inclusion cysts.

Benign

Malignant tumours

Primary Secondary

Primary malignancy is rare (20%)

Skin , soft tissues , embryonic tissue rests

adenocarcinoma is the common primary tumour

Metastatic tumors are the commonest (80%)

stomach, ovary, colon and pancreas

lymphoma, RCC , prostate

mean survival is approximately 10-12 months

Primary secondary

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