Paediatric Surgery Umbilical Conditions
Umbilical cord separation occurs 1-2 weeks after birth. Epithelial cover is attained shortly after and contraction of the linea alba (umbilical ring) defect is gradual and variable taking up to 3 years.
Common in up to 20% infants, 90% undergo spontaneous resolution by 1 year, likely to remain if present after 3 years, risk of incarceration is very low and less than 1%.
Surgical repair is indicated if very large after one year of age, noticeable by preschool child, causes discomfort or becomes incarcerated at any age.
Supra umbilical hernia
Spontaneous resolution unlikely, recurrent pain is common and incarceration of extraperitoneal fat results in painful firm lump. Elective surgical repair recommended after 6 months of age.
Occurs in early infancy. Pink or red, moist, central umbilical lump, flat or on a pedicle yellow low-volume discharge. Standard treatment is daily salt baths, silver nitrate, second to third daily until resolved. Prior application of Vaseline to surrounding skin is suggested for protection from chemical burn. If no response after 3 treatments, consider vitello- intestinal or urachal remnant. Surgical assessment is advisable.
Patent Vitello- intestinal duct or urachus
Appears as moist granuloma, central orifice, faecal discharge (thin, malodourous) or urine (wets clothing). Refer for surgery
Vitello- intestinal or urachal remnant without patent duct
Skin covered lump or like granuloma that fails to resolve with topical treatment, referral for excision is recommended. Urachal remnant abscess presents as swelling below umbilicus, redness and sometimes purulent umbilical discharge
Pus, redness, swelling (not often seen in Australia with good hygiene). It can rapidly progress to cellulitis or necrotizing fasciitis, treat promptly and aggressively. Portal vein thrombosis is a recognized sequela with high mortality.