diseases of umbilicus

2. 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)

7. Umbilical diseases
congenital
Patent vitello-intestinal
duct
Patent urachus
Hernias
inflammatory
Omphalitis.
Umbilical granuloma.
Pilonidal sinus.
GI fistulas
Neoplastic
Benign
Malignant

8. Three types
1. Exomphalos major and minor
2. Childhood hernias
3. adult hernias

9. 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

10. 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

11. 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

12. 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

13. 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

17. 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

18. 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

20. 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

21. 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)

22. 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

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

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

26. 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

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

28. xray abdomen
USG abdomen
CECT abdomen
99mTc scan

29. segmental resection and reconstruction

30. Infection of the retained umbilical cord
Poor asepsis and umbilical hygiene during
delivery
Staphylococci, streptococci, Gram-negative
organisms, Clostridium tetani

31. Abscess
Cellulitis
Gangrene
Peritonotis
Septicemia
Granuloma
Pus discharge

32. Antibiotics
Cauteristaion
Debridement

34. 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

35. 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.

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

39. 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

40. Primary secondary