A six-week-old male infant was brou...

A six-week-old male infant was brought to the office by means of his mother. During a diaper change, she noted a lesion in the umbilicus (see accompanying figure). The infant was born at spell by primary cesarean section. He was feeding well and gaining weight appropriately. The lesion was not noted during a previous office visit when the infant was 10 days advanced in years and still had the umbilical cord attached. forward examination, there was a fine red mass at the base of the umbilicus. Although the lesion was slightly moist, no impure discharge or purulent drainage was not past nor future The surrounding skin was not r warm, or swollen

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Question

Based in succession the history and physical examination, which united of the following is the principally likely diagnosis?

[] A. Umbilical hernia.

[] B Umbilical pyogenic granuloma.

[] C Omphalitis.

[] D Omphalocele.

[] E Patent urachus.

Discussion

The answer is B: umbilical pyogenic granuloma. A solid, r umbilical mass having a yielding velvety appearance without a fistulous tract hints a granuloma. An umbilical pyogenic granuloma is a usual benign abnormality in neonates. It bring outs within the first few weeks of life and should not be near at birth. It forms from exces granulation tissue persisting at the base of the umbilicus after cord separation. (1) Umbilical granulomas repeatedly appear pedunculated and can hide a small amount of serous or serosanguineous drainage.

Umbilical hernias, omphaloceles, and gastroschisis usually are apparent onward gross inspection. Umbilical hernias form as a proceed of a fascial defect that allows viscera to jut when the child strains or cries. Umbilical hernias are shrouded with skin, which helps distinguish them from granulomas and polyp Although considered congenital, umbilical hernias developing during infancy usually are not apparent at birth. Umbilical hernias befall more often in premature infants and those of African American coming down (2) Umbilical hernias spontaneously bring to a period in most children by approximately three years of age and rarely become incarcerated. Taping or strapping the hernia does not hasten resolution. (3)

An omphalocele is a serious congenital condition in which viscera enclos in a sac beetle from a midline defect at the base of the umbilicus. Gastroschisis is characterized through lack of a membranous sac. In gastroschisis, bowel satisfys protrude lateral to an intact umbilical cord. (4) It is important to distinguish these couple abdominal wall defects because an omphalocele is associated with a higher incidence of other anomalies.

Les for the use of all conditions include umbilical polyps, urachal tract, and omphalomesenteric channel remnants. (5) These require surgical correction. Umbilical polyp are firm masses comprised of intestinal or urinary tract tissue. They attend to be larger than granulomas, and do not suit to silver nitrate. A patent urachus is an embryonic conduit that extends from the bladder to the umbilicus and intermittently leaks urine. Umbilical drainage containing bilious or fecal material should ready a work-up to exclude a persistent omphalomesenteric conduit which is a residual communication between the ileum and the umbilicus.

Neonatal umbilical infection, or omphalitis, is characterized by way of redness, induration, and purulent or malodorous drainage from the umbilical stub Symptoms of omphalitis begin couple to three days after birth and may progres to necrotizing fasciitis or systemic infection. (6) Omphalitis must be treated aggressively with antibiotics.

Several noninvasive measures are available to treat umbilical pyogenic granulomas. Granuloma formation is favored when cord separation is delayed and there is inflammation. Thus, applying topical antibiotics and eliminating the friction of a wet diaper may allow the granulation tissue to epithelialize. Conventional management has been to thirsty the umbilical stump and carefully cauterize the granuloma with a 75 percent silver nitrate stick. Because of the risk of drainage, the granuloma can be dried with gauze to avoid chemical bakes or discoloration to the surrounding skin. (7) Furthermore, caution should be exercised if silver nitrate is used for large granulomas because chemicals from repeated applications can leak onto healthy tissue. A small randomized controll application of mind concluded that conservative measures like as air drying with alcohol wipes should be tried before cauterizing with silver nitrate. (8) Persistence of a presum umbilical pyogenic granuloma after repeat applications of silver nitrate warrants further evaluation to method out other pathology.

Cryosurgery electrocautery, salt, and ligature are other treatment options. In undivided small study, cryosurgery was associated with skin depigmentation, unless was favored because repeat applications were unnecessary. (9) Cryotherapy also tendered more rapid healing compared with the use of chemicals and electrocautery. Twice daily application of belonging to all table salt to umbilical pyogenic granulomas for three days is a simple, cost-effective, and curative order that can be performed on parents at home. (10) The application of a double-ligature can be considered for pedunculated umbilical pyogenic granulomas.11 Proponent of this technique caution against using double ligatures upon broad-based or friable lesions and emphasize the importance of first excluding more critical diagnoses. Larger granulomas or those that do not disentangle with the above measures may require surgical excision.