omphalomesenteric duct sinus

OMD sinus

An OMD sinus should be suspected when mucus discharge is noted in the presence of an umbilical polyp or granuloma.

Patent OMD may be identified early in the neonatal period due to persistent feculent discharge.However, cysts and sinus tract may require additional evaluation, including ultrasonography and fistulography.

Management involves surgical exploration to exclude associated OMD or urachal remnants and excision of the duct.

Umbilical cysts

 

Umbilical cysts

Umbilical cysts may present as a firm, erythematous, cystic swelling at the umbilicus but are typically asymptomatic.

In some cases, they may present with bowel obstruction or infection.

Funisitis

 

Funisitis

Funisitis is inflammation of the connective tissue of the umbilical cord that occurs with chorioamnionitis. It involves only the external cord surface and Wharton's jelly. It has no involvement of the vessels.

It does not involve the umbilical stump, which would be seen in omphalitis.

Necrotizing funisitis occurs with long-standing infection and is characterized by inflammatory debris and calcification of umbilical cord tissues.

Infants with funisitis can be born healthy, but should be treated with broad-spectrum antibiotics (similar to the regimen used for omphalitis) for a minimum of seven days of therapy.

UMBILICAL INFECTION

UMBILICAL INFECTION

 Umbilical infections, which can progress to systemic infections and may lead to spesis, occur primarily in the newborn because of the following predisposing factors:
 

1. Immediately following birth, the umbilicus becomes colonized with a diverse flora of microorganisms. Staphylococcal species and other Gram-positive cocci are present within hours, and enteric organisms follow shortly thereafter.
2. Devitalized tissues of the umbilical cord stump provide an excellent growth medium for bacteria.
3. The thrombosed blood vessels within the umbilical cord stump provide an entry for microorganisms into the bloodstream of the neonates, potentially leading to sepsis.

References

1. Rotimi VO, Duerden BI. The development of the bacterial flora in normal neonates. J Med Microbiol 1981; 14:51.
2. Harnden A, Lennon D. Serious suppurative group A streptococcal infections in previously well children. Pediatr Infect Dis J 1988; 7:714.

UMBILICAL GRANULOMA

UMBILICAL GRANULOMA

 After the separation of the cord, granulation tissue may persist at the base as a small mass. The tissue, usually light pink in color, is composed of fibroblasts and capillaries and is typically 1 to 10 mm in diameter.  

Persistent serous or serosanguinous drainage around the umbilicus may be suggestive of an umbilical granuloma.

Umbilical granuloma must be differentiated from umbilical polyps and from granuloma secondary to a patent urachus, both of which do not respond to silver nitrate cauterization.

Conventional treatment of umbilical granulomas includes cauterization with silver nitrate.
Generally, only a few applications of silver nitrate are required for successful treatment.
 

Caution should be exercised in applying silver nitrate because of the risk of chemical burns or temporary discoloration of the surrounding skin.