UmbIlical malformation

Embryologically, the umbilicus is a ‘busy’ place, being the exit site for the umbilical vessels and transmitting important structures related to the developing gastrointestinal and urinary tracts.Abnormalities involving the umbilicus in babies and children are common, and are often a source of great anxiety for patients’ families The abnormalities are -UMBILICAL HERNIA,UMBILICAL GRANULOMA,HERNIA OF THE UMBILICAL CORD,OMPHALOMESENTERIC (VITELLINE) DUCT REMNANTS,URACHAL REMNANTS & NEONATAL OMPHALITIS.

Umbilical hernia - Umbilical hernias form when the umbilical ring is delayed in closing/fails to close completely. Most commonly presents as a reducible painless bulge at umbilicus. Can be more prominent when the baby or child strains or cries.

The complications are rare in umbilical hernias like Incarceration and Strangulation.

surgical indication -symptoms of incarceration/strangulation. Asymptomatic umbilical hernia in children  >4 yrs, defect more then 2 cm and proboscis type hernia .

OMPHALOMESENTERIC (VITELLINE) DUCT- The omphalomesenteric duct (vitelline duct) connects the yolk sac to the small intestine. This duct obliterates when the embryo is about 6 weeks old. Complete failure of the duct to obliterate results in a fistula from the ileum to the umbilicus (vitelline fistula or patent VID).

Symptoms of omphalomesenteric duct remnants-  They may be asymptomatic, common symptoms of omphalomesenteric duct malformations include abdominal pain, rectal bleeding, intestinal obstruction, umbilical drainage, and umbilical Polyp.

Surgical procedure usually involves a circular incision around the umbilical scar giving access to the OMD remnants, proceeding with the remnants resection through the abdominal, reaching the bowel section connected to the fistula.

Patent urachus- Umbilical disorders that result from the failure of involution of normal embryologic tissues that connect the developing bladder to the umbilical cord.

Presentation is variable and can be readily evident at birth with umbilical cord abnormalities or diagnosed later in adolescence with the complaint of persistent umbilical wetness or recurrent umbilical infection.

Surgical management in the form of local exploration with excision versus a laparoscopic approach is generally undertaken.

  Umbilical granuloma - is a moist, red lump of tissue that can form on a baby's navel (belly button). It can be seen in the first few weeks of life, after the umbilical cord has dried and fallen off. It's usually a minor problem that looks worse than it is. An umbilical granuloma does not cause pain.

Treatment is by cautrizing using silver nitrate stick or lots of other things are in practice .

Omphalitis- An infection of the umbilicus and/or surrounding tissues, occurring primarily in the neonatal period. It is limited to around the umbilicus in the majority of newborns. However, it can rapidly progress to systemic infection and death, with an estimated mortality rate between 7% to 15%.

Treatment-Broad-spectrum parenteral antibiotics are required to treat omphalitis. Antibiotic coverage should be directed against both gram-positive and gram-negative organisms