# Urachal Cyst — GCMD Library living collection Everything in the library about urachal cyst — built automatically from dossiers that name it. Updated: n/a · 3 episodes · 54 cited statements ## Episodes ### Diagnosis & Workup - [Umbilical Pathologies Bonus Episode](https://library.globalcastmd.com/watch/umbilical-pathologies-bonus-episode-5331) — podcast · 4:25 · [machine version](https://library.globalcastmd.com/watch/umbilical-pathologies-bonus-episode-5331.md) - [Differential diagnosis and management of pediatric umbilical pathologies](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593) — podcast · 6:19 · [machine version](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593.md) - [Diagnosis and Management of Pediatric Umbilical Pathologies](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595) — podcast · 6:44 · [machine version](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595.md) ## Chapters - [0:02](https://library.globalcastmd.com/watch/umbilical-pathologies-bonus-episode-5331?t=2) Differential diagnosis of umbilical bulge in infants (Ep 1) - [1:00](https://library.globalcastmd.com/watch/umbilical-pathologies-bonus-episode-5331?t=60) Distinguishing features and surgical approach to patent urachus and omphalomesenteric duct (Ep 1) - [1:49](https://library.globalcastmd.com/watch/umbilical-pathologies-bonus-episode-5331?t=109) Umbilical granuloma versus umbilical polyp (Ep 1) - [2:34](https://library.globalcastmd.com/watch/umbilical-pathologies-bonus-episode-5331?t=154) Risk factors and natural history of umbilical hernias (Ep 1) - [3:27](https://library.globalcastmd.com/watch/umbilical-pathologies-bonus-episode-5331?t=207) Surgical technique for pediatric umbilical hernia repair (Ep 1) - [0:00](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=0) Introduction and differential diagnosis of umbilical bulge (Ep 2) - [1:08](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=68) Distinguishing features and surgical approach to urachal and omphalomesenteric remnants (Ep 2) - [2:08](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=128) Umbilical granuloma versus umbilical polyp (Ep 2) - [2:59](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=179) Risk factors and timing of umbilical hernia repair (Ep 2) - [4:12](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=252) Surgical technique for umbilical hernia repair (Ep 2) - [5:21](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=321) Key takeaways and conclusion (Ep 2) - [0:00](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=0) Differential Diagnosis of Umbilical Bulge (Ep 3) - [1:33](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=93) Surgical Management of Patent Urachal and Omphalomesenteric Remnants (Ep 3) - [2:27](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=147) Distinguishing Umbilical Granulomas from Polyps (Ep 3) - [3:35](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=215) Umbilical Hernia Risk Factors and Timing of Repair (Ep 3) - [4:46](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=286) Umbilical Hernia Repair Technique (Ep 3) - [6:07](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=367) Key Takeaways (Ep 3) ## Statements Every statement is attributed, typed, and timestamped; the link is the citation. - Umbilical hernia is the most common cause of umbilical bulge in infants. — Meera Kotagal (clinical) [Ep 1 · 0:34](https://library.globalcastmd.com/watch/umbilical-pathologies-bonus-episode-5331?t=34) - The differential diagnosis of umbilical bulge includes umbilical hernia, urachal cyst, patent omphalomesenteric duct, umbilical granuloma, umbilical polyp, and omphalitis (when significant erythema is present). — Meera Kotagal (clinical) [Ep 1 · 0:34](https://library.globalcastmd.com/watch/umbilical-pathologies-bonus-episode-5331?t=34) - Urine draining from the umbilicus is associated with a patent urachus. — Meera Kotagal (clinical) [Ep 1 · 1:00](https://library.globalcastmd.com/watch/umbilical-pathologies-bonus-episode-5331?t=60) - Succus draining from the umbilicus suggests a patent omphalomesenteric duct. — Meera Kotagal (clinical) [Ep 1 · 1:00](https://library.globalcastmd.com/watch/umbilical-pathologies-bonus-episode-5331?t=60) - An umbilical polyp is a small remnant of the omphalomesenteric duct extending from the umbilicus that can be excised. — Meera Kotagal (clinical) [Ep 1 · 1:56](https://library.globalcastmd.com/watch/umbilical-pathologies-bonus-episode-5331?t=116) - An umbilical granuloma is granulation tissue or asymptomatic pink tissue at the base of the umbilicus, often seen in very small infants shortly after umbilical cord separation, treated with silver nitrate. — Meera Kotagal (clinical) [Ep 1 · 1:56](https://library.globalcastmd.com/watch/umbilical-pathologies-bonus-episode-5331?t=116) - The primary risk factor for umbilical hernias is prematurity. — Meera Kotagal (epidemiological) [Ep 1 · 2:42](https://library.globalcastmd.com/watch/umbilical-pathologies-bonus-episode-5331?t=162) - African-American infants are 8 times more likely to have an umbilical hernia compared to Caucasians. — Meera Kotagal (epidemiological) [Ep 1 · 2:42](https://library.globalcastmd.com/watch/umbilical-pathologies-bonus-episode-5331?t=162) - 85% of infant umbilical hernias will close on their own. — Meera Kotagal (epidemiological) [Ep 1 · 3:09](https://library.globalcastmd.com/watch/umbilical-pathologies-bonus-episode-5331?t=189) - Small umbilical hernia defects are more likely to close spontaneously compared to larger defects (those over 1 to 1.5 centimeters). — Meera Kotagal (clinical) [Ep 1 · 3:09](https://library.globalcastmd.com/watch/umbilical-pathologies-bonus-episode-5331?t=189) - Routine pediatric umbilical hernias are repaired as an outpatient procedure. — Meera Kotagal (clinical) [Ep 1 · 3:28](https://library.globalcastmd.com/watch/umbilical-pathologies-bonus-episode-5331?t=208) - Pediatric umbilical hernia repair does not use mesh, unlike adult repairs. — Meera Kotagal (clinical) [Ep 1 · 3:28](https://library.globalcastmd.com/watch/umbilical-pathologies-bonus-episode-5331?t=208) - During pediatric umbilical hernia repair, it is important to close normal fascia to normal fascia, not hernia sac to hernia sac. — Meera Kotagal (clinical) [Ep 1 · 3:28](https://library.globalcastmd.com/watch/umbilical-pathologies-bonus-episode-5331?t=208) - The differential diagnosis for a pediatric umbilical bulge includes umbilical hernia (most common), urachal cyst, patent omphalomesenteric duct, umbilical granuloma, umbilical polyp, and omphalitis if significant erythema is present. — Meera Kotagal (clinical) [Ep 2 · 0:49](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=49) - Urine draining from the umbilicus is associated with a patent urachus. — Meera Kotagal (clinical) [Ep 2 · 1:17](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=77) - Succus draining from the umbilicus suggests a patent omphalomesenteric duct. — Meera Kotagal (clinical) [Ep 2 · 1:22](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=82) - For excision of urachal or omphalomesenteric remnants, a curvilinear infra-umbilical incision is made, attachments from umbilicus to bladder or intestine are identified and tracked down, then divided. — Meera Kotagal (clinical) [Ep 2 · 1:46](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=106) - An umbilical polyp is a small remnant of the omphalomesenteric duct extending from the umbilicus that can be excised by tying it off and ligating it in clinic, then dividing it or letting it fall off over time. — Meera Kotagal (clinical) [Ep 2 · 2:15](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=135) - An umbilical granuloma is granulation tissue or asymptomatic pink tissue at the base of the umbilicus, often seen in very small infants shortly after cord separation, and is treated with silver nitrate. — Meera Kotagal (clinical) [Ep 2 · 2:29](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=149) - On physical exam, an umbilical polyp has a stalk and can be moved around more freely, whereas granulomatous tissue is more stuck on at the base of the belly button. — Meera Kotagal (clinical) [Ep 2 · 2:49](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=169) - The primary risk factor for umbilical hernias is prematurity. — Meera Kotagal (epidemiological) [Ep 2 · 3:04](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=184) - African-American infants are 8 times more likely to have an umbilical hernia compared to Caucasians. — Meera Kotagal (epidemiological) [Ep 2 · 3:12](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=192) - 85% of infant umbilical hernias will close on their own. — Meera Kotagal (epidemiological) [Ep 2 · 3:30](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=210) - Small umbilical hernia defects are more likely to close spontaneously compared to larger defects (those over 1 to 1.5 cm). — Meera Kotagal (clinical) [Ep 2 · 3:34](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=214) - Really large umbilical hernias may be closed earlier if children are symptomatic or if they are so large that spontaneous closure is unlikely. — Meera Kotagal (clinical) [Ep 2 · 3:40](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=220) - Pediatric umbilical hernia repair is an outpatient procedure involving an infra-umbilical curvilinear incision. — Meera Kotagal (clinical) [Ep 2 · 4:12](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=252) - In umbilical hernia repair, the umbilical stalk is encircled and divided, the hernia sac is separated from skin and fascia to identify fascial edges, and the defect is closed primarily. — Meera Kotagal (clinical) [Ep 2 · 4:19](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=259) - Unlike in adults, mesh is not typically used to repair an umbilical hernia in a child. — Meera Kotagal (clinical) [Ep 2 · 4:33](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=273) - During umbilical hernia repair, it is important to ensure closure extends back to normal fascia and not hernia sac to hernia sac. — Meera Kotagal (clinical) [Ep 2 · 4:38](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=278) - Even with a prominent umbilical proboscis and excess skin, skin resection or formal umbilicoplasty is generally not needed. — Meera Kotagal (clinical) [Ep 2 · 4:52](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=292) - In instances with significant excess skin, umbilicoplasty might be considered, but care must be taken to create what is cosmetically consistent with a normal umbilicus. — Meera Kotagal (opinion) [Ep 2 · 5:11](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=311) - The differential diagnosis for a 6-month-old infant with umbilical bulge includes umbilical hernia (most common), urachal cyst, patent omphalomesenteric duct, umbilical granuloma, umbilical polyp, hernia of the cord, and omphalitis if significant erythema is present. — Meera Kotagal (clinical) [Ep 3 · 0:37](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=37) - Urine draining from the umbilicus is associated with a patent urachus, whereas succus drainage suggests a patent omphalomesenteric duct. — Meera Kotagal (clinical) [Ep 3 · 1:09](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=69) - Umbilical granulomas can cause intermittent serosanguinous drainage. — Meera Kotagal (clinical) [Ep 3 · 1:27](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=87) - For patent urachus or patent omphalomesenteric duct identified on ultrasound, the next step is usually operative exploration. — Meera Kotagal (clinical) [Ep 3 · 1:41](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=101) - Ligation and division of a urachus can be performed through an umbilical incision using a curvilinear fashion in the infraumbilical space. — Meera Kotagal (clinical) [Ep 3 · 1:47](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=107) - For urachal remnant repair, the urachus should be tracked all the way down to the bladder and the bladder is usually repaired at that level in two layers. — Meera Kotagal (clinical) [Ep 3 · 2:09](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=129) - For patent omphalomesenteric duct or remnant, it should be tracked down to the intestine and resected at the level of the intestine, but small bowel resection is not needed. — Meera Kotagal (clinical) [Ep 3 · 2:17](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=137) - An umbilical polyp is a small remnant of the omphalomesenteric duct extending from the umbilicus that can be excised by tying it off and ligating it in clinic, either dividing it or letting it fall off over time. — Meera Kotagal (clinical) [Ep 3 · 2:35](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=155) - An umbilical granuloma is granulation tissue or pink tissue at the base of the umbilicus, often seen in very small infants shortly after umbilical cord separation, and is treated with silver nitrate. — Meera Kotagal (clinical) [Ep 3 · 2:50](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=170) - To differentiate umbilical granuloma from polyp on physical exam, use a Q-tip to spread open the umbilicus and look at the base: a polyp has a stalk and moves more freely, whereas granulomatous tissue is more adherent at the base. — Meera Kotagal (clinical) [Ep 3 · 3:15](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=195) - The primary risk factor for umbilical hernias is prematurity. — Meera Kotagal (epidemiological) [Ep 3 · 3:38](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=218) - African-American infants are 8 times more likely to have an umbilical hernia compared to Caucasians. — Meera Kotagal (epidemiological) [Ep 3 · 3:42](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=222) - For umbilical hernias, repair is generally delayed until the patient is at least 4 years of age, though some recommendations suggest 2 years as the lower age limit. — Meera Kotagal (guideline) [Ep 3 · 3:57](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=237) - 85% of infant umbilical hernias will close on their own. — Meera Kotagal (epidemiological) [Ep 3 · 4:09](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=249) - Small umbilical hernia defects are more likely to close spontaneously compared to larger defects over 1 to 1.5 cm. — Meera Kotagal (clinical) [Ep 3 · 4:14](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=254) - Really large umbilical hernias may be closed earlier if children are symptomatic or if they are so large they are unlikely to close spontaneously. — Meera Kotagal (opinion) [Ep 3 · 4:21](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=261) - If umbilical hernia repair is delayed to closer to 4 years of age, families should be counseled about signs of incarceration or strangulation including abdominal pain, vomiting, skin changes, or a bulge that is not reducible. — Meera Kotagal (clinical) [Ep 3 · 4:33](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=273) - Routine pediatric umbilical hernia repair is an outpatient procedure involving an infraumbilical curvilinear incision, though some surgeons prefer a vertical incision through the umbilicus. — Meera Kotagal (clinical) [Ep 3 · 4:50](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=290) - In pediatric umbilical hernia repair, the umbilical stalk is encircled and divided, the hernia sac is separated from skin and fascia to identify fascial edges, and the defect is closed primarily. — Meera Kotagal (clinical) [Ep 3 · 5:02](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=302) - Unlike in adults, mesh is generally not used for pediatric umbilical hernia repair. — Meera Kotagal (clinical) [Ep 3 · 5:18](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=318) - When closing a pediatric umbilical hernia, it is important to get all the way back to normal fascia and not close hernia sac to hernia sac. — Meera Kotagal (clinical) [Ep 3 · 5:18](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=318) - Even with a prominent proboscis and extra skin at an umbilical hernia site, skin resection or formal umbilicoplasty is generally not needed; tacking down the skin at the center of the repair is sufficient and redundant skin improves over time. — Meera Kotagal (clinical) [Ep 3 · 5:36](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=336) - In instances with significant excess skin, umbilicoplasty might be considered, but care must be taken to create a cosmetically normal-appearing umbilicus. — Meera Kotagal (opinion) [Ep 3 · 5:57](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=357) ## Host summaries Recaps by a host of what the experts said — not the host's own clinical position. - When ultrasound shows patent urachus or patent omphalomesenteric duct, the next step is usually operative exploration. — Ellen Encisco summarizes what Dr. Mira Kotigal said [Ep 1 · 1:25](https://library.globalcastmd.com/watch/umbilical-pathologies-bonus-episode-5331?t=85) - On physical exam, an umbilical polyp has a stalk and can be moved around more freely, whereas granulomatous tissue is more stuck on at the base of the belly button. — Ellen Encisco summarizes what Dr. Mira Kotigal said [Ep 1 · 2:16](https://library.globalcastmd.com/watch/umbilical-pathologies-bonus-episode-5331?t=136) - For umbilical hernias, clinicians generally wait until the patient is at least 4 years of age before surgical repair. — Rod Gerardo summarizes what Dr. Mira Kotigal said [Ep 1 · 2:56](https://library.globalcastmd.com/watch/umbilical-pathologies-bonus-episode-5331?t=176) - When ultrasound shows a urachal remnant or omphalomesenteric duct but cannot distinguish between them, the next step is operative exploration. — Ellen Encisco summarizes what Dr. Mira Kotigal said [Ep 2 · 1:37](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=97) - For urachal remnant excision, the remnant must be tracked all the way down to the bladder, and the bladder is repaired in two layers. — Ellen Encisco summarizes what Dr. Mira Kotigal said [Ep 2 · 2:00](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=120) - For umbilical hernias, repair is usually deferred until the patient is at least 4 years of age. — Rod Gerardo summarizes what Dr. Mira Kotigal said [Ep 2 · 3:23](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=203) - Families should be counseled about signs of umbilical hernia incarceration or strangulation including abdominal pain, vomiting, overlying skin changes, or a bulge that cannot be reduced. — Ellen Encisco summarizes what Dr. Mira Kotigal said [Ep 2 · 3:50](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=230) - Tacking the skin down at the center of the repair is usually sufficient for recreating the umbilicus. — Ellen Encisco summarizes what Dr. Mira Kotigal said [Ep 2 · 5:03](https://library.globalcastmd.com/watch/differential-diagnosis-and-management-of-pediatric-umbilical-pathologies-16593?t=303) - A good history and physical examination is important to differentiate varied umbilical pathologies. — The host summarizing the discussion [Ep 3 · 6:13](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=373) - Most umbilical hernias spontaneously close by 4 years, so repair can be performed at that point if closure does not occur. — The host summarizing the discussion [Ep 3 · 6:21](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=381) - Umbilical polyps are common and can often be managed non-operatively in the clinic. — The host summarizing the discussion [Ep 3 · 6:28](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=388) - For other umbilical pathologies, ultrasound can help identify the pathology and direct surgical intervention. — The host summarizing the discussion [Ep 3 · 6:33](https://library.globalcastmd.com/watch/diagnosis-and-management-of-pediatric-umbilical-pathologies-16595?t=393) ## Changelog - Nov 7: 3 items added automatically --- Educational content from recorded physician discussions — not medical advice. 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