eMedicine Specialties > Pediatrics: Surgery > General Surgery

Disorders of the Umbilicus: Workup

Author: Robert K Minkes, MD, PhD, Professor of Surgery, University of Texas Southwestern; Chief of Surgical Services, Children's Medical Center of Dallas-Legacy
Coauthor(s): Li Ern Chen, MD, Staff Physician, Department of Surgery, Barnes Jewish Hospital, Washington University School of Medicine; Mark V Mazziotti, MD, Assistant Professor of Pediatric Surgery, Department of Surgery, Baylor College of Medicine, Texas Children's Hospital; Eugene S Kim, MD, Consulting Staff, Pediatric Surgeon, Assistant Professor, Division of Pediatric Surgery, Michael E DeBakey Department of Surgery, Assistant Professor, Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine; Attending Pediatric Surgeon, Texas Children's Hospital; Robert S Bloss, MD, Clinical Associate Professor of Surgery and Pediatrics, University of Texas Medical School; Clinical Assistant Professor, Department of Surgery, Baylor College of Medicine; Consulting Staff, Houston Pediatric Surgeons
Contributor Information and Disclosures

Updated: Oct 27, 2008

Workup

Laboratory Studies

  • Routine laboratory tests are not needed in healthy children undergoing umbilical hernia repair or excision of omphalomesenteric or urachal remnants.
  • Infants with necrotizing fasciitis can be extremely ill, and umbilical cultures and blood cultures are needed. Frequent hematologic, electrolyte, and blood gas analyses may be needed.

Imaging Studies

  • Radiography is not indicated in most children with umbilical disorders. Umbilical hernias are diagnosed by means of physical examination. Fistulography or sinography may be performed if a definitive opening is observed within the umbilicus. Ultrasonography is helpful when a mass is present.
  • Fistulography can be performed by injecting water-soluble contrast medium into the opening at the base of the umbilicus. If the track is blind-ended, the child has a sinus; if it enters the intestine or bladder, a fistula is present.
  • Ultrasonography may be useful in identifying cysts of the umbilicus. Evaluating for a urachal cyst is useful; this cyst most commonly appears as a mass between the umbilicus and suprapubic area.
  • Plain radiography may be useful in children with omphalitis. Air in the subcutaneous tissue or muscle planes is an ominous sign.
  • Cystography or cystoscopy may be indicated to identify bladder outlet obstruction in children draining frank urine from a urachal fistula. However, studies suggest that, in most cases, history and ultrasonography are sufficient for the diagnosis.4

Histologic Findings

  • The histology of umbilical remnants depends on the tissue of origin and may reveal intestinal or gastric mucosa. Examination of urachal remnants shows transitional or columnar epithelium.

More on Disorders of the Umbilicus

Overview: Disorders of the Umbilicus
Workup: Disorders of the Umbilicus
Treatment: Disorders of the Umbilicus
Follow-up: Disorders of the Umbilicus
Multimedia: Disorders of the Umbilicus
References
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References

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  3. Cappele O, Sibert L, Descargues J, Delmas V, Grise P. A study of the anatomic features of the duct of the urachus. Surg Radiol Anat. 2001;23(4):229-35. [Medline].

  4. Little DC, Shah SR, St Peter SD, et al. Urachal anomalies in children: the vanishing relevance of the preoperative voiding cystourethrogram. J Pediatr Surg. Dec 2005;40(12):1874-6. [Medline].

  5. Kosloske AM, Bartow SA. Debridement of periumbilical necrotizing fasciitis: importance of excision of the umbilical vessels and urachal remnant. J Pediatr Surg. Jul 1991;26(7):808-10. [Medline].

  6. Ciley RE, Krummel TM. Disorders of the umbilicus. In: Pediatric Surgery. 5th ed. Philadelphia, PA: WB Saunders Co; 1998:1029-43.

  7. Friedman JM. Umbilical dysmorphology. The importance of contemplating the belly button. Clin Genet. Oct 1985;28(4):343-7. [Medline].

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  15. Lee SL, DuBois JJ, Greenholz SK, Huffman SG. Advancement flap umbilicoplasty after abdominal wall closure: postoperative results compared with normal umbilical anatomy. J Pediatr Surg. Aug 2001;36(8):1168-70. [Medline].

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  22. Rowe PC, Gearhart JP. Retraction of the umbilicus during voiding as an initial sign of a urachal anomaly. Pediatrics. Jan 1993;91(1):153-4. [Medline].

  23. Samuel M, Freeman NV, Vaishnav A, Sajwany MJ, Nayar MP. Necrotizing fasciitis: a serious complication of omphalitis in neonates. J Pediatr Surg. Nov 1994;29(11):1414-6. [Medline].

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  26. Steck WD, Helwig EB. Umbilical granulomas, pilonidal disease and the urachus. Surg Gynecol Obstet. 1965;120:1043.

  27. Weik J, Moores D. An unusual case of umbilical hernia rupture with evisceration. J Pediatr Surg. Apr 2005;40(4):E33-5. [Medline].

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Further Reading

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Keywords

umbilical disorders, umbilical granuloma, umbilical infection, omphalitis, omphalomesenteric remnant, umbilical hernia, gastroschisis, omphalocele, delayed separation of the umbilical cord, urachal remnants, abdominal wall defects, umbilical polyps, omphalocele, gastroschisis, dermoid cysts, hemangiomas, inclusion cysts, necrotizing fasciitis, sepsis, Down syndrome, trisomy 13, trisomy 18, Beckwith-Wiedemann syndrome, Staphylococcus aureus, Streptococcus pyogens, bowel obstruction, abdominal distention, tachycardia, purpura, leukocytosis

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Contributor Information and Disclosures

Author

Robert K Minkes, MD, PhD, Professor of Surgery, University of Texas Southwestern; Chief of Surgical Services, Children's Medical Center of Dallas-Legacy
Robert K Minkes, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Coauthor(s)

Li Ern Chen, MD, Staff Physician, Department of Surgery, Barnes Jewish Hospital, Washington University School of Medicine
Li Ern Chen, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, and Sigma Xi
Disclosure: Nothing to disclose.

Mark V Mazziotti, MD, Assistant Professor of Pediatric Surgery, Department of Surgery, Baylor College of Medicine, Texas Children's Hospital
Mark V Mazziotti, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Eugene S Kim, MD, Consulting Staff, Pediatric Surgeon, Assistant Professor, Division of Pediatric Surgery, Michael E DeBakey Department of Surgery, Assistant Professor, Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine; Attending Pediatric Surgeon, Texas Children's Hospital
Eugene S Kim, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for Cancer Research, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Children's Oncology Group, Society of Laparoendoscopic Surgeons, and Texas Medical Association
Disclosure: Nothing to disclose.

Robert S Bloss, MD, Clinical Associate Professor of Surgery and Pediatrics, University of Texas Medical School; Clinical Assistant Professor, Department of Surgery, Baylor College of Medicine; Consulting Staff, Houston Pediatric Surgeons
Robert S Bloss, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Southwestern Surgical Congress, and Texas Pediatric Society
Disclosure: Nothing to disclose.

Medical Editor

Robert Kelly, MD, Chairman, Department of Surgery, Departments of Surgery and Pediatrics, Children's Hospital of the King's Daughters; Associate Professor, Eastern Virginia Medical School
Robert Kelly, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society of Abdominal Surgeons, Medical Society of Virginia, Norfolk Academy of Medicine, and Southern Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Deborah F Billmire, MD, Associate Professor, Department of Surgery, Indiana University Medical Center
Deborah F Billmire, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Phi Beta Kappa, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

CME Editor

H Biemann Othersen Jr, MD, Professor of Surgery and Pediatrics, Emeritus Head, Division of Pediatric Surgery, Medical University of South Carolina
H Biemann Othersen Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, American Cancer Society, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society for Parenteral and Enteral Nutrition, American Surgical Association, American Thoracic Society, British Association of Paediatric Surgeons, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, South Carolina Medical Association, Southeastern Surgical Congress, Southern Medical Association, Southern Society for Pediatric Research, and Southern Thoracic Surgical Association
Disclosure: Nothing to disclose.

Chief Editor

Marleta Reynolds, MD, Professor of Surgery, Feinberg School of Medicine, Northwestern University; Interim Head, Division of Pediatric Surgery, Department of Surgery, Children's Memorial Hospital of Chicago
Marleta Reynolds, MD is a member of the following medical societies: American Pediatric Surgical Association
Disclosure: Nothing to disclose.

 
 
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