Omphalitis Differential Diagnoses

Updated: May 20, 2019
  • Author: Patrick G Gallagher, MD; Chief Editor: Santina A Zanelli, MD  more...
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DDx

Diagnostic Considerations

The clinical picture of omphalitis is sufficiently characteristic that diagnosis can be made with fair certainty on clinical grounds. Determining whether associated complications such as necrotizing fasciitis, myonecrosis, sepsis, septic embolization, or intraabdominal complications are present is important; failure to recognize necrotizing fasciitis or myonecrosis may result in delay of appropriate surgical intervention.

In neonates with omphalitis and either delayed separation of the umbilical cord or neutropenia, the presence of a predisposing anatomic abnormality (eg, patent urachus) or an immunologic problem (eg, leukocyte adhesion deficiency or a neutrophil disorder) must be considered.

Persistence of a portion of the embryonic tract between the bladder and the umbilicus results in various urachal anomalies. A patent urachus, a free communication between the bladder and umbilicus, may result in persistent drainage from the umbilicus, which can be mistaken as a sign of infection. Incomplete obliteration of the urachal remnant may lead to the formation of an isolated extraperitoneal cyst, which can present with a secondary bacterial infection mimicking omphalitis. However, these cysts rarely present with secondary infections in the neonatal period.

Umbilical granulomas, when they occur, typically develop after the first week of life. Composed of excess granulation tissue at the base of the umbilical cord, most granulomas appear after the umbilical cord has separated, although sometimes they are found with incomplete cord separation. The granulomas, which range from 3-10 mm in size, are pink or dark pink in color and have a soft, velvety texture. Because most of these granulomas fail to epithelialize, they are associated with persistent inflammation accompanied by serous or serosanguinous drainage and a tendency for easy bleeding with trauma. Treatment options include topical applications of silver nitrate, excision and application of absorbable hemostatic materials, cryosurgery, and application of various desiccants.

Special concerns

The relatively high incidence of necrotizing fasciitis following omphalitis in the newborn, with its attendant morbidity and mortality, requires close observation and early surgical intervention if any question surrounds the diagnosis.