Umbilical Pathologies Bonus Episode

Umbilical hernia is the most common cause of umbilical bulge in infants.

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).

Urine draining from the umbilicus is associated with a patent urachus.

Succus draining from the umbilicus suggests a patent omphalomesenteric duct.

When ultrasound shows patent urachus or patent omphalomesenteric duct, the next step is usually operative exploration.

An umbilical polyp is a small remnant of the omphalomesenteric duct extending from the umbilicus that can be excised.

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.

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.

The primary risk factor for umbilical hernias is prematurity.

African-American infants are 8 times more likely to have an umbilical hernia compared to Caucasians.

85% of infant umbilical hernias will close on their own.

Small umbilical hernia defects are more likely to close spontaneously compared to larger defects (those over 1 to 1.5 centimeters).

Routine pediatric umbilical hernias are repaired as an outpatient procedure.

Pediatric umbilical hernia repair does not use mesh, unlike adult repairs.

During pediatric umbilical hernia repair, it is important to close normal fascia to normal fascia, not hernia sac to hernia sac.