Pediatric Umbilical Abnormalities

Posted by e-Medical PPT Sunday, March 4, 2012
Abnormalities of Umbilical Cord
Umbilical abnormalities result from failure of umbilical ring to close or persistence of umbilical structures
Understanding embryology of cord is essential in understanding the pathophysiology of umbilical abnormalities

Umbilical Abnormalities
Urachal Abnormalities
Vitelline Duct Abnormalities
Umbilical Hernia
Omphalitis
Delayed Cord Separation

Urachal formation
Bladder forms from ventral portion of cloaca
Bladder descends into pelvis w/ urachus connecting apex to umbilicus
Usually urachus involutes to a fibrous cord – median umbilical ligament

Urachal abnormalities
failure of obliteration of urachus resulting complete or partial patency of urachus
< 1/1000 live births
inflammation or drainage from umbilicus
US, CT, contrast studies, or injection of dye into tract can confirm diagnosis

Infected Urachal cyst
Fever, voiding symptoms, midline hypogastric tenderness, mass, UTI
May drain into bladder or umbilicus
Rarely can rupture into preperitoneal tissues or peritoneal cavity
Cultures - Staph Aureus

Vitelline Duct Abnormalities
Vitelline Duct is connection between midgut and yolk sac
Usually involutes in 7th – 9th weeks

Meckel’s Diverticulum
contains ectopic gastric or pancreatic mucosa
In 2% of population
2 feet from ileocecal valve, antimesenteric border
Majority of symptomatic < 2yrs old

Presentation
Painless GI Bleeding (50%)
 Most common cause of bleeding in children
 Painless, massive, usually self resolving
 Due to mucosal ulceration from acid secretion

Bowel Obstruction (30%)
 Due to intussusception, diverticulum is the lead point
 Sudden severe pain out of proportion to physical exam
 Hydrostatic Barium enema diagnostic, rarely therapeutic

Inflammation – diverticulitis (20%)
 Sx like appendicitis
 Result of lumenal obstruction, bacterial invasion, progressive inflammation
 Ectopic gastric mucosa predisposes
 30% incidence of perforations
 Higher risk of peritonitis

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