Umbilicus disease

disease of umblicus

1. Disorder of umbilicus Dr. R ana P ratap Singh Assistant professor Gen surgery Jss medical college

2. The umbilicus The navel, or umbilicus, is the site of attachment of the fetal umbilical cord and is located along the linea alba.

3. The umbilicus is an inconstant landmark. In the healthy adult it lies at the junction of L3 and L4 vertebrae. It is lower in the infant It is higher in late pregnancy .

4. L inea alba is well defined above and illdefined below S upplied by T10 S egment Porto-caval anastomosis Meeting point of three systems ( vascular , GIT , excretory )

5. Umbilical diseases c o n geni t a l Patent vitello- intestinal duct Patent urachus Hernias inflammatory Omphalitis. Umbilical granuloma. Pilonidal sinus. GI fistulas Neoplastic Benign Ma lign a nt

6. Exomphalos major and minor Childhood hernias A dult hernias

7. it is due to partial or complete failure of return of the midgut into the peritoneum during development 2 types E xomphalos minor E xomphalos major E xomphalos minor has a small sac , cord attached to the summit , easily reducible , treated b strapping for 2 weeks

8. Exomphalos major L arge defect and a large sac U mblical cord is attached to the inferior aspect E mergency treatment P rimary single staged repair or 2 staged repair

9. M:F 2:1 N eonatal sepsis is predisposing F actor U sually amptomatic S trangulation is a rare complication S pontaneous closure occurs by 2 yrs S urgery is indicated if not closed by 4 yrs

10. Umbilical hernias in adults are mostly acquired C ommon in women Predisposing factors are increased intra-abdominal pressure pregnancy obesity ascites abdominal distention single midline aponeurotic decussation Irreducibility , obstruction , strangulation and rupture are common complications

11. Commonly overweight thinned and attenuated midline raphe . The bulge is typically slightly to one side of the umbilical depression, creating a crescent-shaped appearance to the umbilicus Treatment Small hernias – observation Large hernias - open or laparoscopic Primary repair , mayo’s , mesh repair laparoscopy

12. Urac h us a duct between the bladder and the yolk sac - Between the 5th and 7th week of development, the allantois will become the urachus median umblical ligament – obliterated urachus

13. Patent urachal Manifests in new born One-third associated with distal urinary obstruction U rine from umblicus Giant umblical cord complete excision of the tract with a cuff of bladder

14. C ommonest urachal anamoly in adults D ue to persistance of the part of the tract symptoms due to (asymptomatic) size ( mass ) infection( pain , fever, urinary symptoms , umblical discharge ) rupture ( peritonitis )

15. D iagnosis by clinical , usg , and by cect T reatment single stage – complete excision of the tract two stage - I & D followed by complete excision after control of sepsis

16. Due to persistance of the distal urachus asymptomatic unless infected P ain , fever , pus discharge Diagnosed by Usg , sinogram Manage by excision of the sinus tract

17. L east common urachal anamoly A symptomatic I ncidental diagnosis cystoscopy , mcu , usg T reatment usually not required

18. Anomalies connected with the vitellointestinal duct. (a) Umbilical fistula; (b) intra-abdominal cyst; (c) intraperitoneal band;(d) Meckel’s diverticulum with a band adherent to the sac of a congenital umbilical hernia.

19. Most common abnormality of the omphalo - mesenteric duct Antimesenteric border of ileum 50 – 200 cms from ICJ True diverticulum Mostly asymptomatic Lower GI bleed , inflammation , obstruction heterotropic mucosa

20. A symptomatic A bdominal mass Umbilical granuloma U mbilical discharge (faeces & air ) GI bleeding I ntestinal obstruction

21. xray abdomen USG abdomen CECT abdomen 99mTc scan

22. segmental resection and reconstruction

23. Infection of the retained umbilical cord Poor asepsis and umbilical hygiene during delivery Staphylococci, streptococci, Gram-negative organisms, Clostridium tetani

24. Abscess Cellulitis Gangrene Peritonotis Septicemia Granuloma Pus discharge

25. Antibiotics Cauteri s taion Debridement

26. C hronic infection of the umbilical cicatrix, Can occur in any age group, but common in infants and children. Presents as umbilical discharge with tender, red, swelling protruding from the umbilicus which bleeds on touch. M imics umbilical adenoma. Treatment Antibiotics, silver nitrate excision of granuloma umbilectomy

27. C ommonly seen in infants. D ue to partially obliterated vitello-intestinal duct towards umbilical end, causing prolapse of the mucosa Appears as a moist, red swelling bleeds on touch. Secondary infection Histologically, it consists of columnar epithelium rich in goblet cells .

28. most common primary benign tumours were, Congenitalpolyps , melanotic naevi , papillomas , fibromas , myxomas, haemangiomas, and epithelial inclusion cysts.

29. Primary Secondary Primary malignancy is rare (20%) Skin , soft tissues , embryonic tissue rests adenocarcinoma is the common primary tumour Metastatic tumors are the commonest (80%) stomach, ovary, colon and pancreas lymphoma, RCC , prostate mean survival is approximately 10-12 months

30. Primary secondary