Umbilical Granuloma
An umbilical granuloma, a small nodule of tissue measuring up to 1 cm, may become apparent following the separation of the umbilical cord.
It may be confused with umbilical polyps (vide infra or omphalomesenteric duct
remnants).
Clinical features:-
- The surface of an umbilical granuloma may be smooth or irregular.
- Pedunculated
- In case of infection –
- Pain or tenderness around the belly button.
- Swelling or redness around the granuloma.
- Oozing
- Presence of sticky mucus
- Mild irritation of skin around the navel.
Treatment:-
- Silver nitrate: Small granulomas may be treated adequately with applications of topical silver nitrate.
- Liquid nitrogen: This will cause the tissue to freeze and fall off.
- Surgical thread: A doctor may tie off the base of the granuloma with surgical thread. This cuts off blood supply to the tissue, and it will eventually fall off.
- Surgical removal: In a final resort, the doctor can gently remove the tissue using a scalpel or knife
Neonatal Omphalitis
Neonatal umbilical infections are rare in developed countries, reflecting good neonatal care and asepsis.
Omphalitis is an infection of the umbilical stump. It typically
presents as a superficial cellulitis that can spread to involve the
entire abdominal wall and may progress to necrotizing fasciitis,
myonecrosis, or systemic disease.
Staphylococcus and Streptococcus species, as well as Gram- negative and polymicrobial infections, predominate.
Clinical features
- Edema
- Erythema
- Tenderness
- Purulent discharge
- Periumbilical cellulitis
- Gangrene
- Septicemia
Treatment:-
- Antibiotics : Omphalitis should be treated aggressively with parenteral antibiotics clindamycin or metronidazole
- Cauteristaion
- Debridement
Umbilical Hernia
An Umbilical hernia is an abnormal bulge that can be seen or felt at the umbilicus (belly button).
It develops when a portion of the lining of the abdomen, part of the intestine, or fluid from the abdomen, comes through the muscle of the abdominal wall.
This is usually congenital and relates to the incomplete closure of the anterior abdominal wall fascia after the intestines have returned to the abdominal cavity.
These type of hernias are common, occurring in 10%- 20% of all children. They are, however, more
common in African-Americans.
Low birth weight and premature infants are also more likely to have an umbilical hernia.
Clinical features:-
- Umbilical hernias may be especially evident when infant cries, causing the baby’s belly button to protrude. This is a classic sign of an umbilical hernia.
- In children, it is usually painless.
- Sometimes the intestines get trapped within the umbilical hernia. This is referred to as an incarcerated hernia. When this occurs, the child usually has severe pain and the bulge may be firm and red.
- Urgent medical evaluation to exclude an incarcerated hernia is required in order to prevent possible damage to the intestines. It is uncommon for this to occur.
Treatment:-
- Many umbilical hernias close spontaneously by ages 3 to 4. If closure does not occur by this time, surgical repair is usually advised.
- In younger children, if there is an episode of incarceration or if the hernia is very large, surgical repair may be recommended.
- Criteria for surgery in umbilical hernia-
- Painful
- Bigger than 1.5 cm in diameter
- Large and don’t decrease in size over the first 2 years
- Don’t disappear by age of 4
- Trapped or block the intestine
- Do not tape the hernia; it will not speed hernia resolution, but may cause significant skin breakdown
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