Umbilical Pathologies Bonus Episode

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

Differential diagnosis of umbilical bulge includes umbilical hernia, urachal cyst, patent omphalomesenteric duct, umbilical granuloma, umbilical polyp, and omphalitis (if significant erythema present).

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

Succus draining from the umbilicus suggests a patent omphalomesenteric duct.

Operative exploration for patent urachus or patent omphalomesenteric duct uses a curvilinear incision in the infra-umbilical space, with dissection to identify attachments from umbilicus to bladder or intestine, which are then divided.

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

An umbilical granuloma is granulation tissue or asymptomatic pink tissue at the base of the umbilicus, commonly seen in very small infants shortly after umbilical cord separation, treated with silver nitrate.

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 hernia repair is an outpatient procedure.

Pediatric umbilical hernia repair involves an infra-umbilical curvilinear incision, encircling and dividing the umbilical stalk, separating the hernia sac from skin and fascia, identifying fascial edges, and closing the defect primarily.

Unlike in adults, mesh is not used when repairing a child's umbilical hernia.

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