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Tahmasbi H, Haghbin Toutounchi A, Hasanzade A, Sadeghmousavi S, Aghaei M. The omphalomesenteric duct fibrous band as a rare cause of bowel obstruction: A case report and literature review. Int J Surg Case Rep 2024; 116:109354. [PMID: 38340631 PMCID: PMC10943667 DOI: 10.1016/j.ijscr.2024.109354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE The omphalomesenteric duct (OMD) is an embryonic structure that normally undergoes obliteration during embryonic development, typically not persisting after birth. Failure of complete or partial obliteration can result in a type of malformation known as OMD remnant. CASE PRESENTATION We report a case of a 24-year-old male patient diagnosed with bowel obstruction. Abdominal computed tomography (CT) scan revealed the presence of an adhesion band. During surgery, a fibrous band connecting from the umbilicus to the mesentery of terminal ileum was found and resected. Pathological investigation confirmed the presence of an OMD remnant fibrous band. CLINICAL DISCUSSION OMD remnant can manifest in different forms such as Meckel's diverticulum, umbilical polyp, OMD cyst, OMD fistula, and fibrous band, occurring in approximately 2 % of infants and often presenting symptoms in early childhood. These conditions rarely cause complications in adults. Complications may include obstruction, gastrointestinal bleeding, bowel perforation, and omphalitis which can present with symptoms such as abdominal pain, vomiting, melena, lack of defecation, umbilical discharge, and dermal manifestations. Diagnostic approaches vary depending on the type of OMD remnant and associated complications, but ultrasonography and CT scan can be useful. While asymptomatic OMD remnants generally do not require further intervention, surgical treatment is the main option for complicated and symptomatic cases. CONCLUSION OMD remnant is a rare condition in adults that can lead to complications. Given that obstruction is a common complication of OMD remnant, OMD remnant should be considered in the differential diagnosis of patients presenting with bowel obstruction.
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Affiliation(s)
- Hamed Tahmasbi
- Department of General Surgery, Imam Hossein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Haghbin Toutounchi
- Department of General Surgery, Imam Hossein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Arman Hasanzade
- Department of General Surgery, Imam Hossein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Sadeghmousavi
- Department of General Surgery, Imam Hossein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Aghaei
- Department of General Surgery, Imam Hossein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Gelikman DG, Ibanez KR, Ghattas YS, Craver EC, Casas-Melley AT, Ellsworth P, Seth A. Management of urachal anomalies in pediatric patients: A comparison of treatment strategies between pediatric urology and general surgery. J Pediatr Urol 2024; 20:75.e1-75.e8. [PMID: 37802719 DOI: 10.1016/j.jpurol.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 09/06/2023] [Accepted: 09/18/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION Persistence of embryonic urachal structures due to a failure of the urachus to involute into the median umbilical ligament is known as a urachal anomaly (UA). UAs may remain asymptomatic or lead to abdominal pain and recurrent infections. Management of UAs in pediatric patients has historically lacked a clear consensus between conservative and surgical management. While both urologists and general surgeons manage this pathology, a comparison of management style and outcomes between these specialties has not been published to our knowledge. OBJECTIVE To (1) evaluate trends in management of UAs among pediatric urologists and general surgeons across three tertiary care children's hospitals and (2) identify factors that place patients at higher risk for requiring surgery. STUDY DESIGN All patients diagnosed with a UA from 2016 to 2020 at our multi-site institution were identified by ICD-10 code Q64.4 "malformation of the urachus" and retrospectively reviewed. Patient demographics, treatment specialty, remnant subtype, and management strategy were recorded. Data was dichotomized between both urology and general surgery as well as between surgical and nonsurgical intervention to identify and compare management strategies. RESULTS Overall, 143 patients diagnosed with UAs were identified. Of these patients, 74 were treated by urology and 69 were treated by general surgery. Patients who were treated by urology were significantly more likely to receive conservative treatment (66.2% treated conservatively vs. 33.8% treated surgically), while patients treated by general surgery were significantly more likely to undergo surgery (84.1% treated surgically vs. 15.9% treated conservatively, p < .0001). Though, urology was more likely to treat patients who presented incidentally (p < .01), and general surgery was more likely to treat patients who presented with an infected remnant (p < .01). Patients of male sex were more likely overall to receive surgery compared to female patients (p < .01). DISCUSSION Management of UAs by urologists was more conservative than general surgeons. However, both specialties treat distinctly different patient presentations, with urology managing more incidental remnants and general surgery operating on more emergent, infected urachi. Limitations of the study included its retrospective nature and the insufficient reporting of urachal remnant subtypes and presence of infection among patients. CONCLUSIONS Management strategies of UAs differ among urology and general surgery, but surgical and conservative treatments are necessary to appropriately treat their distinct patient populations. This study provides valuable insight into current practices of UA management and may help to inform future treatment.
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Affiliation(s)
- David G Gelikman
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Kristen R Ibanez
- University of Central Florida College of Medicine, Orlando, FL, USA
| | | | - Emily C Craver
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL, USA
| | - Adela T Casas-Melley
- University of Central Florida College of Medicine, Orlando, FL, USA; Department of Surgery, Division of Pediatric Surgery, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL, USA
| | - Pamela Ellsworth
- University of Central Florida College of Medicine, Orlando, FL, USA; Department of Surgery, Division of Urology, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL, USA
| | - Abhishek Seth
- University of Central Florida College of Medicine, Orlando, FL, USA; Department of Surgery, Division of Urology, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL, USA.
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Al‐Tarakji M, Almogtaba M, Al‐Hashimy Y, Moustafa OS, Shehata MS, Al‐Zoubi RM, Ghali MS. Laparoscopic management of intestinal obstruction in a young adult with a virgin abdomen: Unusual presentation of combined vitellointestinal duct remnants: A clinical case report. Clin Case Rep 2024; 12:e8395. [PMID: 38239756 PMCID: PMC10794868 DOI: 10.1002/ccr3.8395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 01/22/2024] Open
Abstract
Key Clinical Message In an 18-year-old, Meckel's diverticulum and a rare vitellointestinal fibrous band caused bowel obstruction. Clinicians should be vigilant for such anomalies, especially in young adults with virgin abdomens, as potential sources of intestinal obstruction. Abstract In this case report, we highlight the rarity of vitellointestinal or omphalomesenteric duct anomalies causing intestinal obstruction in the adult population. The patient, an 18-year-old male, presented to the emergency department with a two-day history of abdominal pain and vomiting. Physical examination revealed mild distension of his virgin abdomen with generalized tenderness. Abdominal X-ray displayed dilated small bowel loops, and a computed tomography scan indicated features consistent with closed-loop bowel obstruction. Diagnostic laparoscopy confirmed a vitellointestinal duct remnant as the cause of the small intestinal obstruction, involving a combined Meckel's diverticulum and vitellointestinal fibrous band. In early fetal development, the vitellointestinal duct communicates between the midgut and the yolk sac, expected to disappear during fetal growth. Failure to obliterate can lead to issues such as intestinal blockage, primarily observed in children, making occurrences in adults, as in this case, infrequent with only a few documented instances. Despite its uncommon occurrence in young adults, healthcare providers should consider the vitellointestinal duct anomalous remnant as a potential source of intestinal obstruction, particularly in individuals with a virgin abdomen. Early detection of intestinal obstruction is imperative for patient survival, facilitating prompt management and minimizing the risk of serious morbidities, ultimately contributing to a better patient outcome.
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Affiliation(s)
| | - Mohamed Almogtaba
- Department of Surgery, Acute Care SurgeryHamad Medical CorporationDohaQatar
| | - Yaseen Al‐Hashimy
- Department of Surgery, Acute Care SurgeryHamad Medical CorporationDohaQatar
| | - Omar S. Moustafa
- Department of Surgery, General SurgeryHamad Medical CorporationDohaQatar
| | - Mona S. Shehata
- Department of Pharmacy, Woman's Wellness and Research CenterHamad Medical CorporationDohaQatar
| | - Raed M. Al‐Zoubi
- Surgical Research Section, Department of SurgeryHamad Medical CorporationDohaQatar
- Department of Biomedical Sciences, QU‐Health, College of Health SciencesQatar UniversityDohaQatar
| | - Mohamed Said Ghali
- Department of Surgery, Acute Care SurgeryHamad Medical CorporationDohaQatar
- Department of General SurgeryAin Shams UniversityCairoEgypt
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Sugimoto T, Tahara K, Uchida K, Yoshimoto K. Efficacy of adhesive strapping on umbilical hernia in children: a systematic review and meta-analysis of cohort studies. WORLD JOURNAL OF PEDIATRIC SURGERY 2023; 6:e000633. [PMID: 37860276 PMCID: PMC10582974 DOI: 10.1136/wjps-2023-000633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/30/2023] [Indexed: 10/21/2023] Open
Abstract
Background Although adhesive strapping (AS) for pediatric umbilical hernia (UH), which was once obsolete, has been reconsidered as a common practice in Japan, its efficacy is still unclear. This study aimed to evaluate its efficacy by reviewing related articles. Methods A comprehensive literature search of PubMed, Cochrane, Google Scholar, and Igaku Chuo Zasshi via Ichushi-Web was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Cohort studies reporting on the UH closure rate after AS compared with observation-only management were included. Results A total of 10 cohort studies were included, and the overall UH closure rate was not statistically significant (p=0.31, risk ratio (RR)=0.76, 95% confidence interval (CI) 0.45 to 1.28). However, there were significant differences in the UH closure rate at the age of 6 months (p<0.01, RR=0.55, 95% CI 0.41 to 0.75) and the efficacy of preventing protruding umbilici with redundant skin (p=0.049, RR=0.16, 95% CI 0.03 to 0.99). Conclusions Although the efficacy of AS on UH compared with observation-only management did not differ in terms of the UH closure rate, the application of AS may be effective for faster UH closure and the prevention of protruding umbilici. However, due to the high heterogeneity of the study, further large-scale studies, particularly randomized controlled trials, are warranted to reach a conclusion. PROSPERO registration number CRD42022314417.
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Affiliation(s)
- Takuya Sugimoto
- Department of Pediatric Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Kazunori Tahara
- Department of Pediatric Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Koshi Uchida
- Department of Pediatric Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Kazuhiko Yoshimoto
- Department of Pediatric Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
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5
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Tonosaki K, Suzuki Y, Yonenaga K, Tomimoto K, Yuzawa K, Oku S, Eto S. Infantile umbilical hernia tape fixation method without compression materials. J Gen Fam Med 2023; 24:223-230. [PMID: 37484134 PMCID: PMC10357089 DOI: 10.1002/jgf2.626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 04/16/2023] [Accepted: 04/30/2023] [Indexed: 07/25/2023] Open
Abstract
Background Compression therapy using compression material is often used for umbilical hernias in infants; however, there are problems regarding its use, such as appearance and cost. In our hospital, we use the tape fixation method without compression materials. We report the effectiveness of this method, its significance in measuring the degree of hernia bulge before treatment, and parent satisfaction with the treatment. Methods We analyzed 77 cases of umbilical hernias (41 boys and 36 girls, mean age 52.7 ± 18.3 days) that were treated with the tape fixation method at the Department of Pediatrics of our hospital. Hernia size was classified based on the height of the bulge: mild (<1 cm), moderate (1≦ and <3 cm), or severe (>3 cm). Treatment duration was compared between the groups using the Steel-Dwass test. After the treatment, a questionnaire was mailed to the parents to assess the treatment satisfaction. Results Seventy-three patients (94.8%) achieved closure of the hernia orifice, with no excess skin and a well-shaped umbilicus. The duration of treatment was significantly shorter, with the following order: mild (18.5 ± 8.2 days), moderate (25.0 ± 11.9 days), and severe cases (47.8 ± 11.7 days). According to the questionnaire, 97.5% of the parents were satisfied with the treatment. Conclusions Our tape fixation method without compression material achieved a high closure rate and a good shape of the umbilicus. In addition, we noted that the height of the hernia bulge can be used as a guide to estimate the duration of treatment.
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Affiliation(s)
- Kanata Tonosaki
- Department of PediatricsMisawa City HospitalAomoriJapan
- Department of General MedicineTowada City HospitalAomoriJapan
- Department of Eat‐Loss Medicine, Graduate School of MedicineUniversity of TokyoTokyoJapan
| | - Yuki Suzuki
- Department of PediatricsMisawa City HospitalAomoriJapan
| | - Kazumichi Yonenaga
- Department of General MedicineTowada City HospitalAomoriJapan
- Department of Eat‐Loss Medicine, Graduate School of MedicineUniversity of TokyoTokyoJapan
| | | | | | - Shiori Oku
- Department of PediatricsMisawa City HospitalAomoriJapan
| | - Shuji Eto
- Department of PediatricsMisawa City HospitalAomoriJapan
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Ellul S, Mizzi C, Gatt N, Galea J. Omphalomesenteric duct & Urachal remnant presentation in a newborn. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023. [DOI: 10.1016/j.epsc.2023.102608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
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7
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Goel T, Sharma S, Kandasamy D, Bajpai M. Omphalocele with bladder prolapse through wide patent urachus. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023. [DOI: 10.1016/j.epsc.2023.102577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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8
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Yano T, Okajima T, Tsuchiya S, Tsujimura H. Microbiota in Umbilical Dirt and Its Relationship with Odor. Microbes Environ 2023; 38:ME23007. [PMID: 37407492 PMCID: PMC10522843 DOI: 10.1264/jsme2.me23007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/19/2023] [Indexed: 07/07/2023] Open
Abstract
The umbilicus accumulates more dirt than other body surfaces and is difficult to clean. Hygiene in this area is vital, particularly for surgery, because of its proximity to the laparotomy site. Although microorganisms in the umbilicus have been extensively examined, those in umbilical dirt have not due to the lack of an efficient method of collection. We previously established a technique to extract umbilical dirt using the anchor effect of polymers, which are injected into the umbilicus. In the present study, we applied this technique for the first time to investigate umbilical dirt. The results obtained revealed an abundance of Corynebacterium among various bacteria, whereas Cutibacterium and Staphylococcus, which are abundant at other skin sites, were rare. The relationships between the microbiota and issues related to the umbilicus were investigated and some covariates, including the odor score and several bacteria, were identified. A detailed ana-lysis of the genera associated with odor revealed no correlation with Corynebacterium; however, some minor anaerobic bacteria, such as Mobiluncus, Arcanobacterium, and Peptoniphilus, were more abundant in the high odor score group. Therefore, this technique to collect umbilical dirt provided insights into the microbiota in umbilical dirt and suggested functions for minor anaerobes. Furthermore, since various pathogenic microorganisms were detected, their control may contribute to the prevention of both odor production and infectious diseases caused by these microorganisms.
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Affiliation(s)
- Takehisa Yano
- Safety Science Research Laboratories, Kao Corporation, 2606 Ichikai, Haga, Tochigi 321–3497, Japan
| | - Takao Okajima
- R&D Strategy, Kao Corporation, 2–1–3 Bunka, Sumida, Tokyo, 131–8501, Japan
| | - Shigeki Tsuchiya
- Analytical Science Research Laboratories, Kao Corporation, 2606 Ichikai, Haga, Tochigi 321–3497, Japan
| | - Hisashi Tsujimura
- Analytical Science Research Laboratories, Kao Corporation, 2606 Ichikai, Haga, Tochigi 321–3497, Japan
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Karakas C, Katzman PJ, Wakeman DS, Chacon M. Umbilical Appendix Masquerading as a Patent Omphalomesenteric Duct in a Neonate. Pediatr Dev Pathol 2022; 25:474-478. [PMID: 35344403 DOI: 10.1177/10935266221078500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The umbilicus is the site of a number of well-recognized and unusual abnormalities. Well-known neonatal umbilical abnormalities include umbilical hernias, granulomas/polyps, and congenital remnants of development. In this article, we describe a rare case of an appendix draining through the umbilicus of a neonate. In the literature, there are only 15 cases with possible umbilical appendix. We describe this rare case along with a review of the literature and discuss the underlying pathophysiology.
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Affiliation(s)
- Cansu Karakas
- Departments of Pathology and Laboratory Medicine (Box 626) and Surgery (Box SURG), 6923University of Rochester Medical Center, NY, USA
| | - Philip J Katzman
- Departments of Pathology and Laboratory Medicine (Box 626) and Surgery (Box SURG), 6923University of Rochester Medical Center, NY, USA
| | - Derek S Wakeman
- Departments of Pathology and Laboratory Medicine (Box 626) and Surgery (Box SURG), 6923University of Rochester Medical Center, NY, USA
| | - Miranda Chacon
- Departments of Pathology and Laboratory Medicine (Box 626) and Surgery (Box SURG), 6923University of Rochester Medical Center, NY, USA
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10
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Sakurai T, Ikeda M, Nakamura M, Watanabe T, Endo N. Cellulitis due to adhesive strapping for umbilical hernias. Pediatr Int 2022; 64:e15223. [PMID: 35831263 DOI: 10.1111/ped.15223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 03/16/2022] [Accepted: 04/20/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Tsuyoshi Sakurai
- Department of Neonatology, Miyagi Children's Hospital, Sendai, Japan
| | - Miki Ikeda
- Department of Pediatric Surgery, Miyagi Children's Hospital, Sendai, Japan
| | - Megumi Nakamura
- Department of Neonatology, Miyagi Children's Hospital, Sendai, Japan
| | - Tatsuya Watanabe
- Department of Pediatric Surgery, Miyagi Children's Hospital, Sendai, Japan
| | - Naobumi Endo
- Department of Neonatology, Miyagi Children's Hospital, Sendai, Japan
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11
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Olthof DC, Reemst S, Sleeboom C, Kuijper CF, van Schuppen J, Derikx JPM, Gorter RR. Diagnostic accuracy of abdominal ultrasound to detect pathology that needs surgical exploration in children with umbilical discharge. J Pediatr Surg 2021; 56:1436-1440. [PMID: 32951887 DOI: 10.1016/j.jpedsurg.2020.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/08/2020] [Accepted: 07/16/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Umbilical discharge is common in children and mostly attributed to infection or granuloma. However, an underlying congenital abnormality warranting surgery might also be present. Ultrasound is the imaging modality of choice to diagnose the presence of a congenital abnormality. The aim of this study is to investigate diagnostic accuracy of the ultrasound to detect pathology requiring surgical excision. METHODS All patients ≤18 years with umbilical discharge from January 2008 to September 2019 were retrospectively included. Diagnostic accuracy, i.e., sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR-), were calculated. RESULTS Eighty-one patients were included and 56 were operated. The ultrasound was false positive in 10 patients and false negative in 13 patients. The sensitivity of ultrasound was 71.1% (95% CI 55.7-83.6), specificity 72.2% (54.8-85.8), PPV 76.2% (64.7-84.8), NPV 66.7% (54.8-76.8), LR+ 2.6 (1.5-4.5) and LR- 0.40 (0.2-0.7). CONCLUSIONS This study shows that the diagnostic accuracy of ultrasound for detecting underlying congenital abnormalities warranting surgery for umbilical discharge in the pediatric population is low, even with experienced pediatric radiologists. Therefore, the role of the ultrasound in the diagnostic workup and value in clinical decision making is limited. TYPE OF STUDY Study of diagnostic test. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Sophie Reemst
- Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - C F Kuijper
- Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - J P M Derikx
- Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
| | - R R Gorter
- Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
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Singh A, Naranje K, Pandita A, Upadhyaya VD, Kumar B, Upadhyaya AD. Is application of salt for 3 days locally is sufficient to treat umbilical granuloma? Afr J Paediatr Surg 2021; 18:160-163. [PMID: 34341201 PMCID: PMC8362916 DOI: 10.4103/ajps.ajps_50_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The falling of Umbilical stump occurs by 7-15 days of age. The healing of umbilical stump may be complicated by Umbilical Granuloma. It is often treated by chemical cauterisation which require repeated applications and may lead to local or systemic complications. Common salt by way of its dessicative property may help in treatment of Umbilical Granuloma. OBJECTIVE The objective of the study is to assess the role of common salt application in umbilical granuloma. MATERIALS AND METHODS This is retrospective study over 3 years from a pediatric surgery unit in Northern India. The study subjects were infants less than 10 weeks of age who presented with umbilical granuloma. The method of salt application was 1 pinch of common salt for 1 hour twice a day for 3 consecutive days. The babies were assessed at day 5th for resolution. The success was defined as thrice resolution after 3 cycles. The baseline demographic details were taken and the association of success of treatment was analyzed. RESULTS A total of 36 infants were given treatment in form of common salt application for treatment of umbilical granuloma. The success of around 96% and the cases which presented early responded well. Most of the cases resolved after 3 cycles of treatment. CONCLUSION The common salt application is effective in treatment of granuloma without any side effects.
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Affiliation(s)
- Anita Singh
- Department of Neonatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, (SGPGIMS), New Delhi, India
| | - Kirti Naranje
- Department of Neonatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, (SGPGIMS), New Delhi, India
| | - Aakash Pandita
- Department of Neonatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, (SGPGIMS), New Delhi, India
| | - Vijai D Upadhyaya
- Department of Pediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, (SGPGIMS), New Delhi, India
| | - Basant Kumar
- Department of Pediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, (SGPGIMS), New Delhi, India
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Sánchez Hernández ÁE, Mogollón G, Luengas P, Del Rio S, Rotterman M, Mora N, Rueda S, Holguín DA, Cabrera LF, Rodríguez M, Piñeros S. Divertículo de Meckel en asociación a onfalocele y tetralogía de Fallot: reporte de caso y revisión de la literatura. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
El onfalocele o exónfalos se definen como un defecto congénito de la pared abdominal, que consiste en la herniación de las vísceras abdominales a través del anillo umbilical. Esta entidad rara vez se asocia a la comunicación del divertículo de Meckel con el saco del onfalocele. Teniendo en cuenta la escasa prevalencia de dicha entidad, compartimos el reporte de caso de un paciente recién nacido, con diagnóstico de onfalocele menor, en quien se sospechaba ruptura del saco, sin embargo, de manera intraoperatoria se encontró que la aparente ruptura del saco, correspondía a la comunicación con un divertículo de Meckel. El caso además se asoció con hallazgos ecocardiográficos de tetralogía de Fallot.
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14
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Kitano A, Moroi T, Miura Y, Suginohara Y, Suefuji E, Oohira T, Kuwahara T, Egami K, Haraguchi Y. Usefulness of adhesive strapping for umbilical hernias of infants. Pediatr Int 2021; 63:306-310. [PMID: 32949067 PMCID: PMC8048623 DOI: 10.1111/ped.14464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 08/02/2020] [Accepted: 08/31/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Using a controlled trial, this study aimed to evaluate the effectiveness of adhesive strapping to improve the natural healing rate of umbilical hernia. METHODS This prospective, observational study included 128 patients from Kumamoto, Japan (97 in the adhesive strapping group, and 31 in observation group), from 2012-2015. The duration from first hospital visit to the hernia orifice closure was compared between the two groups. RESULT Kaplan-Meier curves showed that the probability of umbilical hernia in the adhesive strapping group was lower until approximately 200 days, but it was not statistically significant in the log rank test. According to multivariate Cox proportional hazard models, the hazard risk of umbilical hernia in the adhesive strapping group was significantly higher within 0-60 days after adjusting for confounding factors such as hernial cavity and hernia orifice area (P < 0.0001). CONCLUSION Adhesive strapping of umbilical hernia was significantly associated with earlier closure of the hernia orifice from baseline until at least 60 days.
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Affiliation(s)
| | - Toshihiro Moroi
- Department of Pediatrics, Taragi Municipal Hospital, Kumamoto, Japan
| | | | | | | | | | - Toshiko Kuwahara
- Kuwahara Clinic of Internal Medicine and Pediatrics, Kumamoto, Japan
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Nakajima Y, Kondoh S, Yuzuriha S, Yasunaga Y. Umbilical shapes predict future protrusion in pediatric umbilical hernias. Pediatr Int 2020; 62:1162-1170. [PMID: 32359028 DOI: 10.1111/ped.14274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 03/12/2020] [Accepted: 04/15/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study was conducted to evaluate the incidence and early predictive factors of the development of protuberant umbilicus in pediatric umbilical hernia patients. METHODS In this retrospective visual and chart review, patients younger than 3 months with umbilical hernias who initially visited Ina Central Hospital from April 2011 to March 2017 and were followed until they started to walk (at the age of 1 year) were evaluated. The umbilici of the patients at the age of 1 year were classified into two types based on their appearance: concave and protuberant umbilici. Single-factor and logistic regression analyses of the association between the appearance of the umbilicus at the age of 1 year and various clinical data were performed. RESULTS Of the 103 patients, 72% had concave umbilici, and 28% had protuberant umbilici. Single-factor analysis showed significant differences in the umbilical shapes at the initial visit (P < 0.001) and straining habit (P < 0.001). The most ideal logistic regression model demonstrated that umbilici of the highly inflated balloon type (odds ratio, 27.00; 95% confidence interval odds ratio, 5.60-130.08) and crescent type (odds ratio, 14.34; 95% confidence interval odds ratio, 4.22-48.77) were more likely to develop into protuberant umbilici. CONCLUSIONS Umbilical shapes at the initial visit can be used to predict the future development of protuberant umbilici in pediatric patients with umbilical hernias.
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Affiliation(s)
- Yuta Nakajima
- Department of Plastic Surgery, Ina Central Hospital, Ina, Nagano, Japan
| | - Shoji Kondoh
- Department of Plastic Surgery, Ina Central Hospital, Ina, Nagano, Japan
| | - Shunsuke Yuzuriha
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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16
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Delforge X, Havet E, Mesureur S, Hamzy M, Haraux E, Buisson P. Congenital appendicoumbilical fistula. Pediatr Neonatol 2019; 60:684-685. [PMID: 31575459 DOI: 10.1016/j.pedneo.2019.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 11/29/2018] [Accepted: 09/09/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Xavier Delforge
- Department of Pediatric Surgery, CHU Amiens-Picardie, F-80054, Amiens, France.
| | - Eric Havet
- Department of Organogenesis and Anatomy, Université de Picardie Jules Verne, 80036, Amiens, France
| | - Sébastien Mesureur
- Department of Pediatric Surgery, CHU Amiens-Picardie, F-80054, Amiens, France
| | - Mounia Hamzy
- Department of Pediatric Surgery, CHU Amiens-Picardie, F-80054, Amiens, France
| | - Elodie Haraux
- Department of Pediatric Surgery, CHU Amiens-Picardie, F-80054, Amiens, France
| | - Philippe Buisson
- Department of Pediatric Surgery, CHU Amiens-Picardie, F-80054, Amiens, France
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17
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Grottling E, Gisselsson D. Changes in the Prevalence of Embryologic Remnants in Umbilical Cord With Gestational Age. Pediatr Dev Pathol 2019; 22:288-291. [PMID: 30541421 DOI: 10.1177/1093526618813663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to examine the prevalence of embryologic remnants in umbilical cords of different gestational ages. Sections from 392 umbilical cords were examined using light microscopy. Of these, 52% contained at least 1 remnant, most commonly of the allantoic duct type. Although there was a significant decrease in vitelline duct remnants over increasing gestational age, from 11% at weeks 11-25 to 1.6% at weeks 36-42 (P = .009; χ2 test), the allantoic duct remnants remained constant in prevalence irrespective of gestational age.
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Affiliation(s)
- Emma Grottling
- 1 Section for Pediatric Surgery, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - David Gisselsson
- 2 Department of Clinical Genetics, Lund University, Lund, Sweden.,3 Department of Oncology-Pathology, Lund University, Lund, Sweden.,4 Department of Pathology, Skåne Region University and Clinical Laboratories, Lund, Sweden
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18
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Oliveira CS, Pessanha I, Santos L, Machado M, Zenha R. Visual Diagnosis: 21-day-old Boy with an Umbilical Drainage. Pediatr Rev 2019; 40:e25-e27. [PMID: 31263050 DOI: 10.1542/pir.2017-0206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Inês Pessanha
- Department of Pediatric Surgery, Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - Liliana Santos
- Department of Pediatric Surgery, Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - Marta Machado
- Department of Pediatrics, Baixo Vouga Medical Center, Aveiro, Portugal
| | - Raquel Zenha
- Department of Pediatrics, Baixo Vouga Medical Center, Aveiro, Portugal
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19
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Cutaneous presentations of omphalomesenteric duct remnant: A systematic review of the literature. J Am Acad Dermatol 2019; 81:1120-1126. [PMID: 30797849 DOI: 10.1016/j.jaad.2019.02.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 02/13/2019] [Accepted: 02/17/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Disorders of the umbilicus are commonly seen in infancy, including hernias, infections, anomalies, granulomas, and malignancies. Meticulous inspection of the umbilicus at birth might reveal a persisting embryonic remnant, such as an omphalomesenteric duct (OMD), manifested by a variety of cutaneous signs, such as an umbilical mass, granulation tissue, or discharge. OBJECTIVE To systematically review the available data regarding the presence and management of OMD remnant with cutaneous involvement to suggest a practical approach for diagnosis and treatment. METHODS A systematic review of the literature evaluating OMD anomalies presenting with cutaneous symptoms was performed. In addition, an index case of an 11-month-old patient is presented. RESULTS We included 59 publications reporting 536 cases; 97% of the patients whose age was noted were infants (mean age 11 months). In 7.5% of the cases, diagnosis was established only after treatment failure. In 6.4% of patients, nonlethal complications were reported, and in 10.3%, the outcome was death, partly due to delayed diagnosis or mismanagement. LIMITATIONS Limited quality of the collected data, reporting bias. CONCLUSION OMD is relatively rare; however, the clinician must consider this remnant while examining patients with umbilical abnormalities because mismanagement could cause severe morbidity and mortality.
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20
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Kong CKY, Zi Xean K, Li FX, Chandran S. Umbilical cord anomalies: antenatal ultrasound findings and postnatal correlation. BMJ Case Rep 2018; 2018:bcr-2018-226651. [PMID: 30366896 DOI: 10.1136/bcr-2018-226651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Umbilical cord anomalies are rare. The differential diagnosis for a cystic structure around the umbilical cord and its insertion include pseudocyst, omphalomesenteric duct cyst, haemangioma, omphalocele or anterior abdominal wall defects. Although cord anomalies can be detected through antenatal ultrasound scans (US), very often a definitive diagnosis cannot be made. This may affect the management of the infant at birth. In cases where antenatal US was not diagnostic, current evidence supports the use of MRI to help in making an accurate diagnosis. We report two cases of umbilical cord anomalies. The first case was diagnosed in antenatal US as an omphalocele, but was found to be an allantoic cyst with hamartoma on postnatal diagnosis. The second case was not detected on antenatal US, and was diagnosed postnatally as a small omphalocele with vitellointestinal duct remnants.
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Affiliation(s)
| | - Khoo Zi Xean
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Fay Xiangzhen Li
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Suresh Chandran
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Yong Loo Lian School of Medicine, National University of Singapore, Singapore.,Duke-NUS Medical School, Singapore
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21
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Date K, Yokota T, Maehara N. Laparoscopic treatment of intestinal obstruction due to a vitelline vascular remnant and simultaneous appendicitis: a case report. Surg Case Rep 2018; 4:105. [PMID: 30167990 PMCID: PMC6117226 DOI: 10.1186/s40792-018-0515-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 08/23/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The presence of a vitelline vascular remnant is rare, and definitive preoperative diagnosis is difficult. We herein describe a case of intestinal obstruction caused by a vitelline vascular remnant with mild chronic appendicitis successfully diagnosed and treated with laparoscopic surgery. CASE PRESENTATION A 14-year-old male was admitted to our hospital with sudden-onset right lower abdominal pain and vomiting. A blood test on admission revealed slight leukocytosis. Computed tomography scan showed that the appendiceal wall was enhanced and thickened. Although the ileum was slightly dilated and ascites was present at the recto-vesical pouch, these were thought to be inflammatory changes secondary to appendicitis. Laparoscopic surgery was performed using three trocars. Strangulated small bowel obstruction caused by a band connecting the right medial umbilical fold to the ileal mesentery was found intraoperatively. After reduction, neither ischemic change of the small intestine nor Meckel's diverticulum was detected. The appendix was slightly inflamed, and serous ascites was present at the recto-vesical pouch; therefore, appendectomy was also performed. The patient was discharged on postoperative day 4 without complications. Pathological examination revealed that the band consisted of blood vessels, and it was diagnosed as a vitelline vascular remnant. The appendix included fecal stones and showed chronic inflammatory change histologically; the patient was thus diagnosed with chronic appendicitis. CONCLUSIONS Definitive preoperative diagnosis of a vitelline vascular remnant, especially with coexisting appendicitis, might be difficult. Laparoscopic surgery might be useful for patients who demonstrate unusual symptoms because it allows for simultaneous diagnosis and treatment.
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Affiliation(s)
- Kenjiro Date
- Department of Surgery, Fujimoto General Hospital, 17-1 Hayasuzu-cho, Miyakonojo, Miyazaki, 885-0055, Japan.
| | - Taro Yokota
- Department of Surgery, Fujimoto General Hospital, 17-1 Hayasuzu-cho, Miyakonojo, Miyazaki, 885-0055, Japan
| | - Naoki Maehara
- Department of Surgery, Fujimoto General Hospital, 17-1 Hayasuzu-cho, Miyakonojo, Miyazaki, 885-0055, Japan
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22
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Abstract
The umbilical cord, a vital conduit between the placenta and the fetus, loses much of its significance after birth. However, newborns can often present with various abnormalities of the umbilicus, such as benign granulomas or more serious lesions due to persistent remnants, many of which can change the normal course of cord separation and may be associated with significant morbidities if left unrecognized and uncorrected. Although not uncommon, sanguineous drainage from the umbilical stump can be quite alarming to new parents. Parental counseling regarding normal umbilical cord changes, as well as abnormal findings, such as discharge and skin changes, are important for the recognition and timely treatment of potentially significant umbilical cord disorders.
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Affiliation(s)
- Hemananda Muniraman
- Division of Neonatal-Perinatal Medicine, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Tara Sardesai
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Smeeta Sardesai
- Division of Neonatal-Perinatal Medicine, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
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23
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Hayashida M, Shimozono T, Meiri S, Kurogi J, Yamashita N, Ifuku T, Yamamura Y, Tanaka E, Ishii S, Shimonodan H, Mihara Y, Kono K, Nakatani K, Nishiguchi T. Umbilical hernia: Influence of adhesive strapping on outcome. Pediatr Int 2017; 59:1266-1269. [PMID: 28833971 DOI: 10.1111/ped.13406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/26/2017] [Accepted: 08/14/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adhesive strapping for umbilical hernia has been re-evaluated as a promising treatment. We evaluated the influence of adhesive strapping on the outcome of umbilical hernia. METHODS We retrospectively evaluated patients with umbilical hernia referred to the present institution from April 2011 to December 2015. Patients who were treated with adhesive strapping were compared with an observation alone group. The adhesive strapping group was also subdivided into two groups: the cure group and the treatment failure group. RESULTS A total of 212 patients with umbilical hernia were referred to the present institution. Eighty-nine patients were treated with adhesive strapping, while 27 had observation only. The cure rate in the adhesive strapping group was significantly higher than that in the observation group. The duration of treatment of the adhesive strapping group was significantly shorter than that of the observation group. In the adhesive strapping group, the patients in the cure group were treated significantly earlier than those in the treatment failure group (P < 0.001). Furthermore, even in cases of umbilical hernia non-closure, surgical repair was easier after adhesive strapping. CONCLUSION Adhesive strapping represents a promising treatment for umbilical hernia. To achieve the best results, adhesive strapping should be initiated as early as possible.
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Affiliation(s)
- Makoto Hayashida
- Department of Pediatric Surgery, Miyazaki Prefectural Miyazaki Hospital, Miyazaki City, Miyazaki, Japan
| | - Takashi Shimozono
- Department of Pediatric Surgery, Miyazaki Prefectural Miyazaki Hospital, Miyazaki City, Miyazaki, Japan.,Department of Surgery, Miyazaki Prefectural Miyazaki Hospital, Miyazaki City, Miyazaki, Japan
| | - Satoru Meiri
- Department of Pediatrics, Miyazaki Prefectural Miyazaki Hospital, Miyazaki City, Miyazaki, Japan
| | - Jun Kurogi
- Department of Pediatrics, Miyazaki Prefectural Miyazaki Hospital, Miyazaki City, Miyazaki, Japan
| | - Naoto Yamashita
- Department of Pediatrics, Miyazaki Prefectural Miyazaki Hospital, Miyazaki City, Miyazaki, Japan
| | - Toshinobu Ifuku
- Department of Neonatology, Miyazaki Prefectural Miyazaki Hospital, Miyazaki City, Miyazaki, Japan
| | - Yoshiko Yamamura
- Department of Pediatrics, Miyazaki Prefectural Miyazaki Hospital, Miyazaki City, Miyazaki, Japan
| | - Etsuko Tanaka
- Department of Pediatrics, Miyazaki Prefectural Miyazaki Hospital, Miyazaki City, Miyazaki, Japan
| | - Shigeki Ishii
- Department of Pediatrics, Miyazaki Prefectural Miyazaki Hospital, Miyazaki City, Miyazaki, Japan
| | - Hidemi Shimonodan
- Department of Pediatrics, Miyazaki Prefectural Miyazaki Hospital, Miyazaki City, Miyazaki, Japan
| | - Yuka Mihara
- Department of Pediatrics, Miyazaki Prefectural Miyazaki Hospital, Miyazaki City, Miyazaki, Japan
| | - Keiichiro Kono
- Department of Neonatology, Miyazaki Prefectural Miyazaki Hospital, Miyazaki City, Miyazaki, Japan
| | - Keigo Nakatani
- Department of Pediatrics, Miyazaki Prefectural Miyazaki Hospital, Miyazaki City, Miyazaki, Japan
| | - Toshihiro Nishiguchi
- Department of Neonatology, Miyazaki Prefectural Miyazaki Hospital, Miyazaki City, Miyazaki, Japan
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24
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Abstract
Complications related to general pediatric surgery procedures are a major concern for pediatric surgeons and their patients. Although infrequent, when they occur the consequences can lead to significant morbidity and psychosocial stress. The purpose of this article is to discuss the common complications encountered during several common pediatric general surgery procedures including inguinal hernia repair (open and laparoscopic), umbilical hernia repair, laparoscopic pyloromyotomy, and laparoscopic appendectomy.
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Affiliation(s)
- Maria E Linnaus
- Department of Surgery, Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, Arizona 85016
| | - Daniel J Ostlie
- Department of Surgery, Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, Arizona 85016.
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25
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Poorly understood and often miscategorized congenital umbilical cord hernia: an alternative repair method. Hernia 2016; 21:449-454. [PMID: 27878457 DOI: 10.1007/s10029-016-1544-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 11/11/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Umbilical cord hernia is poorly understood and often miscategorized as "omphalocele minor". Careless clamping of the cord leads to iatrogenic gut injury in the situation of umbilical cord hernia. This study aimed to determine the characteristics and outcomes of umbilical cord hernias. We also highlight an alternative repair method for umbilical cord hernias. METHODS We recorded 15 cases of umbilical cord hernias over 10 years. The patients' data were retrospectively reviewed, and preoperative preparation of the newborn, gestational age, birth weight, other associated malformations, surgical technique used, enteral nutrition, and length of hospitalization were recorded. RESULTS This study included 15 neonates with umbilical cord hernias. The mean gestational age at the time of referral was 38.2 ± 2.1 <weeks. Mean birth weight was 3094.3 ± 636.8 g. Four infants had associated malformations, including agenesis of the right kidney, left kidney with a duplex system, coarctation of the aorta, ventricular septal defect, meningocele, club foot, and choanal atresia. Surgical exploration was carried out in all of the neonates and they underwent corrective surgery with good outcomes. CONCLUSIONS In an umbilical cord hernia, the body folds develop normally and form the umbilical ring. The double purse-string technique is easy to apply and produces satisfactory cosmetic results in neonates with umbilical cord hernias.
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26
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Carter A, Enders A. Placentation in mammals: Definitive placenta, yolk sac, and paraplacenta. Theriogenology 2016; 86:278-87. [DOI: 10.1016/j.theriogenology.2016.04.041] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 11/13/2015] [Accepted: 03/14/2016] [Indexed: 12/12/2022]
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27
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Jegou MH, Dufau JP, Kluger N. [Benign colonic metaplasia of the umbilicus]. Ann Dermatol Venereol 2016; 143:583-4. [PMID: 27216306 DOI: 10.1016/j.annder.2016.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 03/19/2016] [Accepted: 03/31/2016] [Indexed: 10/21/2022]
Affiliation(s)
- M-H Jegou
- Cabinet de dermatologie, 8, rue Jules-Ferry, 33290 Blanquefort, France.
| | - J-P Dufau
- Laboratoire d'anatomie et cytologie pathologiques, IHCP, 114, avenue Léon-Blum, 33110 Le Bouscat, France
| | - N Kluger
- Departments of dermatology, allergology and venereology, university of Helsinki, Helsinki university central hospital, 00029 HUS, Finlande
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28
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Yanagisawa S, Kato M, Oshio T, Morikawa Y. Reappraisal of adhesive strapping as treatment for infantile umbilical hernia. Pediatr Int 2016; 58:363-8. [PMID: 26624557 DOI: 10.1111/ped.12858] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 09/15/2015] [Accepted: 09/29/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Most umbilical hernias spontaneously close by 3-5 years of age; therefore, surgical repair is considered only in children whose hernias have not closed by this point. At present, adhesive strapping is not the preferred treatment for umbilical hernias because of the lack of supporting evidence regarding its efficacy, and its association with skin complications. This aim of this study was to examine umbilical hernia closure on ultrasonography, and reassess the merits of adhesive strapping. METHODS Between January 2013 and December 2014, 89 infants underwent adhesive strapping for umbilical hernia. The strapping was changed once a week. The diameter of the hernia orifice was measured on ultrasonography every 2 weeks until closure. The closure speed (CS) of the hernia orifice was compared between the infants treated with adhesive strapping and those undergoing observation alone. The association between CS and birthweight, gestational age, diameter of the hernia orifice, and timing of treatment (before 12 weeks of age vs between 12 and 26 weeks of age) was also analyzed. RESULTS Closure was achieved after 2-13 weeks of strapping in 81 infants (91%), and the likelihood of closure was not affected by the diameter of the hernia orifice, gestational age, or the timing of treatment. The mean CS of the infants treated with adhesive strapping was significantly faster than that of the infants undergoing observation alone (2.59 vs 0.37 mm/week, P < 0.05). Adhesive strapping was discontinued in five of the 89 infants (5.6%) due to severe skin complications. CONCLUSION Adhesive strapping promoted early spontaneous umbilical hernia closure compared with observation alone, regardless of the diameter of the hernia orifice. Adhesive strapping is an effective alternative to surgery and observation.
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Affiliation(s)
- Satohiko Yanagisawa
- Department of Pediatric Surgery, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Mototoshi Kato
- Department of Pediatric Surgery, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Takehito Oshio
- Department of Pediatric Surgery, International University of Health and Welfare Hospital, Tochigi, Japan.,Department of Pediatric Surgery, Shikoku Central Hospital, Shikokuchuo, Japan
| | - Yasuhide Morikawa
- Department of Pediatric Surgery, International University of Health and Welfare Hospital, Tochigi, Japan
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29
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30
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Abstract
Umbilical cord cysts warrant evaluation for structural defects and chromosomal anomalies such as trisomy 18, depending on the type of cyst. The appearance of an enlarged or "gigantic" cord has particular association with a patent urachus, often requiring operative exploration to repair the associated urachal remnant. We describe the unusual case of an umbilical cord cyst-measuring 9 cm in maximal diameter and comprising histopathological features of an urachalcyst-presenting in a healthy ex-36 week newborn with no associated anomalies.
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Affiliation(s)
- Marie Nguyen
- a Division of Pediatric Surgery, Children's Hospital Los Angeles, Keck School of Medicine , University of Southern California , Los Angeles , California , USA.,b Department of Radiology , Oregon Health and Science University , Portland , Oregon , USA
| | - Benjamin Addicott
- b Department of Radiology , Oregon Health and Science University , Portland , Oregon , USA
| | - Julia Chu
- c Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Keck School of Medicine , University of Southern California , Los Angeles , California , USA
| | - David Parham
- c Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Keck School of Medicine , University of Southern California , Los Angeles , California , USA
| | - Eugene Kim
- a Division of Pediatric Surgery, Children's Hospital Los Angeles, Keck School of Medicine , University of Southern California , Los Angeles , California , USA
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31
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Carazo Palacios M, Rodríguez Caraballo L, Llorens Salvador R, Pemartín Comella B, Gutiérrez Sanromán C. ¿Seguro que es un granuloma? An Pediatr (Barc) 2015; 83:358-9. [DOI: 10.1016/j.anpedi.2015.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 05/31/2015] [Accepted: 06/04/2015] [Indexed: 10/23/2022] Open
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32
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Pathak A, Agarwal N, Singh P, Dhaneria M. Prolapse of inverted ileal loops through a patent vitellointestinal duct. BMJ Case Rep 2015; 2015:bcr-2015-211563. [PMID: 26494719 DOI: 10.1136/bcr-2015-211563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of a prolapsed patent vitellointestinal duct (PVID) in a 2-month-old girl child who presented with sudden increase in size of a polypoidal lesion into a large, 'Y'-shaped reddish, prolapsing lesion, discharging gaseous and faecal matter at her umbilicus. The lesion was diagnosed as a prolapse of inverted ileal loops through the PVID. The child had no associated congenital anomalies. A transumbilical exploration was performed, followed by wedge resection and anastomosis. The child tolerated the procedure well and the postoperative course was uneventful. If the omphalomesenteric duct fails to obliterate a range of congenital defects related to the umbilicus, it can become clinically apparent. Meckel's diverticulum is the commonest of these defects but is most often asymptomatic. PVID is the most common symptomatic anomaly of the patent omphalomesenteric duct and requires prompt surgical correction to avoid complications.
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Affiliation(s)
- Ashish Pathak
- Department of Pediatrics, RD Gardi Medical College, Ujjain, Madhya Pradesh, India Department of Public Health Sciences, Global Health (IHCAR), Stockholm, Solna, Sweden Department of Women and Children's Health, International Maternal and Child Health Unit, Uppsala University, Uppsala, Sweden
| | - Nitin Agarwal
- Department of Paediatric Surgery, RD Gardi Medical College, Ujjain, Madhya Pradesh, India
| | - Poonam Singh
- Department of Pediatrics, RD Gardi Medical College, Ujjain, Madhya Pradesh, India
| | - Mamta Dhaneria
- Department of Pediatrics, RD Gardi Medical College, Ujjain, Madhya Pradesh, India
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33
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Wang H, Gao Y, Duan Y, Zheng B, Guo X. Dramatic Response of Topical Doxycycline in Umbilical Granuloma: Report of 84 Cases. Glob Pediatr Health 2015; 2:2333794X15607315. [PMID: 27335979 PMCID: PMC4784640 DOI: 10.1177/2333794x15607315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We previously observed that topical doxycycline powder was effective in the treatment of umbilical granuloma. This study aims to evaluate the efficacy of this agent. The patients were randomly assigned into inpatient group and outpatient group. Doxycycline powder was administered topically once daily for 5 days. The protocol was restarted if no response observed. Eighty-four patients were included in this study. With one course of therapy, the overall cure rate was 82.14% (69/84), and the statistical difference in response rate was not significant between the 2 groups (P > .05). With 2 courses of therapy, the overall cure rate was 94.05% (79/84). No complication was observed during treatment. No recurrence was observed during follow-up. The treatment of umbilical granuloma using topical doxycycline is safe and efficacious. The administration of the agent can be performed conveniently by parents at home. This protocol could be considered to be the first treatment option for this disorder in neonates and infants.
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Affiliation(s)
- Huaijie Wang
- Second Affiliated Hospital, Medical College of Xi'an JiaoTong University, Xi'an, China
| | - Ya Gao
- Second Affiliated Hospital, Medical College of Xi'an JiaoTong University, Xi'an, China
| | - Yitao Duan
- Second Affiliated Hospital, Medical College of Xi'an JiaoTong University, Xi'an, China
| | - Baijun Zheng
- Second Affiliated Hospital, Medical College of Xi'an JiaoTong University, Xi'an, China
| | - Xinkui Guo
- Second Affiliated Hospital, Medical College of Xi'an JiaoTong University, Xi'an, China
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Penninga L, Timmerman P, Reurings JC, Nellensteijn DR. Simultaneous occurrence of Meckel's diverticulum and patent urachus. BMJ Case Rep 2015; 2015:bcr-2015-210147. [PMID: 26156836 DOI: 10.1136/bcr-2015-210147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The simultaneous occurrence of a Meckel's diverticulum and a patent urachus is very uncommon. We describe the occurrence and surgical treatment of Meckel's diverticulum and an urachal anomaly in a 1-year-old boy. The patient had intermittent production of clear fluid from the patent urachus, which disappeared after surgical resection.
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Affiliation(s)
- Luit Penninga
- Department of Surgery, St Elisabeth Hospital, Willemstad, Curaçao
| | - Pieter Timmerman
- Department of Surgery, St Elisabeth Hospital, Willemstad, Curaçao
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Brødsgaard A, Nielsen T, Mølgaard U, Pryds O, Pedersen P. Treating umbilical granuloma with topical clobetasol propionate cream at home is as effective as treating it with topical silver nitrate in the clinic. Acta Paediatr 2015; 104:174-7. [PMID: 25297721 DOI: 10.1111/apa.12824] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 08/29/2014] [Accepted: 10/06/2014] [Indexed: 11/28/2022]
Abstract
AIM There is a lack of evidence on the best treatment option for umbilical granuloma. The primary aim of this study was to compare three treatments for umbilical granuloma: standard treatment with topical silver nitrate, clobetasol propionate cream (0.05%) and ethanol wipes. The secondary aim was to evaluate whether the treatment could be successfully administered by a parent at home, rather than in the outpatient clinic. METHODS A total of 109 infants were randomised to one of three groups and 94 infants completed the assigned treatment: 30 infants received standard treatment with silver nitrate (99%) in the outpatient clinic, 30 infants had topical clobetasol propionate cream (0.05%) applied at home, and 34 infants received cleansing with ethanol wipes (82%) at home. RESULTS Silver nitrate and clobetasol propionate cream (0.05%) were significantly superior to ethanol wipes, with shorter healing times and higher resolution rates (p = 0.0001). Healing time and resolution rates were identical for silver nitrate and clobetasol propionate cream (0.05%). Mild side effects were occasionally reported, all of which were self-limiting. CONCLUSION Treating umbilical granuloma with topical clobetasol propionate cream (0.05%) at home is as effective as treating it with topical silver nitrate (99%) in the clinic.
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Affiliation(s)
- Anne Brødsgaard
- Department of Paediatrics; Hvidovre Hospital; The Capital Region; University of Copenhagen; Copenhagen Denmark
| | - Tove Nielsen
- Department of Paediatrics; Hvidovre Hospital; The Capital Region; University of Copenhagen; Copenhagen Denmark
| | - Ulla Mølgaard
- Department of Paediatrics; Hvidovre Hospital; The Capital Region; University of Copenhagen; Copenhagen Denmark
| | - Ole Pryds
- Department of Paediatrics; Hvidovre Hospital; The Capital Region; University of Copenhagen; Copenhagen Denmark
| | - Pernille Pedersen
- Department of Paediatrics; Hvidovre Hospital; The Capital Region; University of Copenhagen; Copenhagen Denmark
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Bagade S, Khanna G. Imaging of omphalomesenteric duct remnants and related pathologies in children. Curr Probl Diagn Radiol 2015; 44:246-55. [PMID: 25823549 DOI: 10.1067/j.cpradiol.2014.12.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 12/23/2014] [Accepted: 12/29/2014] [Indexed: 01/01/2023]
Abstract
The omphalomesenteric duct (OMD) or the vitelline duct (VD) is the embryologic communication between the yolk sac and the primitive midgut. OMD or VD anomalies are a group of defects resulting from failure of involution of the OMD. Meckel diverticulum is the most common anomaly that results from failure of resorption of the OMD. Other less common anomalies seen in children include OMD fibrous band, fistula, sinus tract, cyst, and umbilical polyps. These OMD remnants can have variable clinical manifestations such as umbilical discharge, small bowel obstruction, gastrointestinal tract bleeding, or acute abdomen. This pictorial essay reviews the clinical presentation and imaging findings of the common and not so common complications of OMD remnants in the pediatric population.
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Affiliation(s)
- Swapnil Bagade
- Mallinckrodt Institute of Radiology, Washington University, St Louis, MO.
| | - Geetika Khanna
- Mallinckrodt Institute of Radiology, Washington University, St Louis, MO
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CHEN DUQUN, LI YIFAN, YU ZUHU, SU ZHENGMING, NI LIANGCHAO, GUI YAOTING, YANG SHANGQI, SHI BENTAO, LAI YONGQING. Investigating urachal carcinoma for more than 15 years. Oncol Lett 2014; 8:2279-2283. [PMID: 25295114 PMCID: PMC4186584 DOI: 10.3892/ol.2014.2502] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 07/15/2014] [Indexed: 02/05/2023] Open
Abstract
Urachal carcinomas are rare bladder malignances, which usually present at an advanced stage with a high risk of distant metastases and a poor prognosis. To improve understanding of this uncommon carcinoma, a retrospective review was conducted for the cases observed at Peking University Shenzhen Hospital and Peking University First Hospital. The clinical outcomes were analyzed for 17 patients with a diagnosis of urachal cancer, who were admitted to Peking University Shenzhen Hospital (Shenzhen, China) and Peking University First Hospital (Beijing, China) between 1998 and 2013. The TNM staging system was used to predict outcomes. Among the 17 study patients, there were 10 males and seven females, with a median age at diagnosis of 50 years. A total of four (23%) patients presented with lymph node or distant metastasis. The median overall survival time for all stages was 57.6 months, with five patients (38.4%) alive for more than five years following treatment. The application of the TNM staging system demonstrated a median survival time of 6.2 years for stage I/II patients, compared with a median survival of 1.8 years (log-rank, P<0.001) for patients with advanced disease (stages III and IV). In addition, no significant correlation was observed between tumor size and age, and survival. In conclusion, urachal carcinomas are usually locally advanced at presentation. Surgical excision remains the predominant choice of treatment and lymph node dissection is not required unless lymph node involvement is confirmed by preoperative examination. The current results indicated that the most significant predictor of prognosis was the tumor grade.
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Affiliation(s)
- DUQUN CHEN
- Department of Urology, Anhui Medical University, Hefei, Anhui 230032, P.R. China
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
- The Guangdong and Shenzhen Key Laboratory of Male Reproductive Medicine and Genetics, Institute of Urology of Shenzhen PKU-HKUST Medical Center, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
| | - YIFAN LI
- Department of Urology, Anhui Medical University, Hefei, Anhui 230032, P.R. China
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
- The Guangdong and Shenzhen Key Laboratory of Male Reproductive Medicine and Genetics, Institute of Urology of Shenzhen PKU-HKUST Medical Center, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
| | - ZUHU YU
- Department of Urology, Anhui Medical University, Hefei, Anhui 230032, P.R. China
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
- The Guangdong and Shenzhen Key Laboratory of Male Reproductive Medicine and Genetics, Institute of Urology of Shenzhen PKU-HKUST Medical Center, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
| | - ZHENGMING SU
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
- The Guangdong and Shenzhen Key Laboratory of Male Reproductive Medicine and Genetics, Institute of Urology of Shenzhen PKU-HKUST Medical Center, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
- Department of Urology, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
| | - LIANGCHAO NI
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
- The Guangdong and Shenzhen Key Laboratory of Male Reproductive Medicine and Genetics, Institute of Urology of Shenzhen PKU-HKUST Medical Center, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
| | - YAOTING GUI
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
- The Guangdong and Shenzhen Key Laboratory of Male Reproductive Medicine and Genetics, Institute of Urology of Shenzhen PKU-HKUST Medical Center, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
| | - SHANGQI YANG
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
- The Guangdong and Shenzhen Key Laboratory of Male Reproductive Medicine and Genetics, Institute of Urology of Shenzhen PKU-HKUST Medical Center, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
| | - BENTAO SHI
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
- The Guangdong and Shenzhen Key Laboratory of Male Reproductive Medicine and Genetics, Institute of Urology of Shenzhen PKU-HKUST Medical Center, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing 100034, P.R. China
- Correspondence to: Professor Yongqing Lai or Dr Bentao Shi, Department of Urology, Institute of Urology of Shenzhen PKU-HKUST Medical Center, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, Guangdong 518036, P.R. China, E-mail: , E-mail:
| | - YONGQING LAI
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
- The Guangdong and Shenzhen Key Laboratory of Male Reproductive Medicine and Genetics, Institute of Urology of Shenzhen PKU-HKUST Medical Center, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
- Correspondence to: Professor Yongqing Lai or Dr Bentao Shi, Department of Urology, Institute of Urology of Shenzhen PKU-HKUST Medical Center, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, Guangdong 518036, P.R. China, E-mail: , E-mail:
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Kluger N. Dermatoses ombilicales et péri-ombilicales. Ann Dermatol Venereol 2014; 141:224-35; quiz 223, 236. [DOI: 10.1016/j.annder.2013.10.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 10/17/2013] [Accepted: 10/21/2013] [Indexed: 11/16/2022]
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Marshall ASJ, Jayapal SSK, Whitburn JAS, Akinbiyi BA, Willetts IE. Recognising serious umbilical cord anomalies. BMJ Case Rep 2013; 2013:bcr-2013-201663. [PMID: 24285812 DOI: 10.1136/bcr-2013-201663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Umbilical vessel catheterisation is a common intervention in neonatal care. Many complications are recognised, some of which are life-threatening. We report the case of a term neonate who was compromised at birth following antepartum haemorrhage with evidence of multiorgan ischaemic injury. Following resuscitation and umbilical vessel catheterisation, she developed pneumoperitoneum. At laparotomy, a patent vitellointestinal duct was identified and resected. Intestinal perforation was found in the duct wall, most plausibly explained by the unintentional catheterisation of the duct via the umbilicus. Learning to recognise umbilical cord anomalies, such as patent vitellointestinal duct, can be simple and could prevent potentially serious complications.
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Affiliation(s)
- Andrew S J Marshall
- Department of Paediatrics, Oxford University Hospitals, Children's Hospital, Oxford, UK
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Hirashima K, Uchino R, Kume S, Iyama KI, Honda Y, Asato T, Baba H. Intra-abdominal mucinous adenocarcinoma of urachal origin: report of a case. Surg Today 2013; 44:1156-60. [PMID: 23689950 DOI: 10.1007/s00595-013-0620-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 12/09/2012] [Indexed: 10/26/2022]
Abstract
Intra-abdominal mucinous cystic tumors can be difficult to diagnose preoperatively. We report a case of histologically diagnosed primary urachal adenocarcinoma: a rare type of bladder tumor. This case report is interesting for clinicians. The patient was an 86-year-old man who presented with acute abdominal pain. Computed tomography (CT) showed a large cystic mass with calcification, near the apex of the urinary bladder. Laparotomy revealed a large intra-abdominal cystic mass adherent to the anterior abdominal wall and superior to the urinary bladder. We performed laparoscopic-assisted resection and partial cystectomy. The cystic mass measured approximately 15 × 14 × 11 cm and contained mucinous material. Histological examination revealed that it extended to the muscle of the bladder wall and that its epithelium was composed of atypical cells with increased papillary morphology. The mucinous material was glycoprotein with degenerative fatty tissue, and calcification was recognized partly in the specimen. Thus, we comprehensively diagnosed a mucinous cystic adenocarcinoma of urachal origin.
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Affiliation(s)
- Kotaro Hirashima
- Department of Surgery, Kumamoto City Ueki Hospital, 285-29 Iwano, Ueki-machi, Kita-ku, Kumamoto City, Kumamoto, 861-0136, Japan,
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Kondrich J, Woo T, Ginsburg HB, Levine DA. Evisceration of small bowel after cauterization of an umbilical mass. Pediatrics 2012; 130:e1708-10. [PMID: 23166332 DOI: 10.1542/peds.2012-0623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The omphalomesenteric duct (OMD), a temporary structure essential to fetal development, normally involutes completely by week 8 or 9 of gestation. On occasion, the OMD persists, the clinical presentations of which vary widely. We describe a case of a 6-week-old male with a patent OMD remnant that was initially treated as an umbilical granuloma, which then potentially allowed for prolapse of the small bowel through the umbilical ring. The patient required resection of the incarcerated bowel but had an otherwise uneventful and complete recovery.
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Affiliation(s)
- Janienne Kondrich
- Division of Pediatric Emergency Medicine, New York University Langone Medical Center, New York, NY 10016, USA
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43
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A rare confounder in a case of ovarian torsion. Eur J Obstet Gynecol Reprod Biol 2012; 163:121-2. [DOI: 10.1016/j.ejogrb.2012.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 03/17/2012] [Accepted: 04/01/2012] [Indexed: 11/15/2022]
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Abstract
The umbilicus is the main access route to the abdominal cavity in laparoscopic surgeries. However, its anatomical configuration is rarely studied in the surgical and anatomical literature. With introduction of laparoendoscopic single-site surgery and considering the significant number of primary and postoperative umbilical hernias, we felt the necessity to comprehensively study the umbilical structures and analyze their protective function against hernias. Twenty-four embalmed cadavers were studied in the anatomy laboratory of Case Western Reserve University. Round hepatic, median and medial ligaments, umbilical ring, umbilical and umbilicovesicular fasciae, and pattern of attachment to the ring were dissected and measured. Mean age was 82.1 years, ranging between 56 and 96 years, with a male-to-female ratio of 1.4:1. Ninety-two per cent was white and 8 per cent black adults. According to shape and attachment pattern of ligaments, umbilical ring is classified into five types. Hernia incidence was 25 per cent. All hernia cases lacked the umbilical fascia and the round hepatic ligament was not attached to the inferior border of the ring. The umbilical ring and its morphologic relation with adjacent ligaments are described and classified into five types. In contrary to sparse existing literature, we propose that umbilical fascia is continuation and condensation of umbilicovesicular rather than transversalis fascia. It was absent in cadavers forming conjoined median and medial ligaments with a single insertion site to the ring. Round ligament insertion to the inferior border of the ring provides another protective factor. These two protective measures were absent in all the observed umbilical hernias.
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Affiliation(s)
- Amir H. Fathi
- Departments of General Surgery, Case Western Reserve University and Case Medical Center, Cleveland, Ohio
| | - Hooman Soltanian
- Plastic Surgery, Case Western Reserve University and Case Medical Center, Cleveland, Ohio
| | - Alan A. Saber
- Departments of General Surgery, Case Western Reserve University and Case Medical Center, Cleveland, Ohio
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Widni EE, Höllwarth ME, Haxhija EQ. The impact of preoperative ultrasound on correct diagnosis of urachal remnants in children. J Pediatr Surg 2010; 45:1433-7. [PMID: 20638520 DOI: 10.1016/j.jpedsurg.2010.01.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Revised: 12/23/2009] [Accepted: 01/02/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Ultrasound is a noninvasive imaging method used widely in urachal diagnostics. This study investigated the effectiveness of ultrasonography in correctly depicting urachal anomalies in children. METHODS Preoperative ultrasound findings of all patients who were operated on for suspected urachal anomalies between 1990 and 2008 were retrospectively compared with the final diagnosis. RESULTS Fifty-three patients (31 female, 22 male; approximately 2.6 years; range, 0-17 years) were reviewed. In 37 patients, the final diagnosis of an urachal anomaly matched the ultrasound findings. In 7 patients, there was a false-positive ultrasound finding, and in 9 patients, there was a false-negative ultrasound finding. Three of 4 patients with urachal cysts, 23 of 29 patients with urachal fistulas, and 8 of 10 patients with urachal sinuses were correctly identified by ultrasonography. In 10 patients, no urachal rests were found intraoperatively: in 7 of these patients, urachal rests were falsely suspected by ultrasound. The positive predictive value for ultrasound is 83%, whereas the negative predictive value is 25%. The sensitivity for this diagnostic method is 79% and the specificity 30%. CONCLUSIONS Ultrasound helps to identify urachal anomalies in case of their presence but is not helpful to rule out a nonexisting urachal anomaly.
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Affiliation(s)
- Eva E Widni
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, 3036 Graz, Austria
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Durakbasa CU, Okur H, Mutus HM, Bas A, Ozen MA, Sehiralti V, Tosyali AN, Zemheri IE. Symptomatic omphalomesenteric duct remnants in children. Pediatr Int 2010; 52:480-4. [PMID: 19863751 DOI: 10.1111/j.1442-200x.2009.02980.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The present study gathers a single institutional experience of symptomatic omphalomesenteric duct (OMD) remnants in children with an emphasis on the age and modes of presentation, the surgical intervention and the histopathological findings. METHODS The data on children who underwent surgical treatment for symptomatic OMD remnants during a 17-year period were reviewed retrospectively, excluding incidental diverticulectomies. RESULTS A total of 59 children with a median age of 36 months underwent operations for symptomatic OMD remnants. There were 48 boys and 11 girls. The presenting signs were gastrointestinal tract (GIT) obstruction in 21 (36%) patients, acute abdomen in 18 (31%), umbilical abnormalities in 17 (29%), and rectal bleeding in three (5%). Patients presenting with umbilical anomalies were significantly younger than others. At surgery, a wedge resection of the remnant was carried out in 32 cases and an ileal resection was carried out in 27. Children presenting with GIT obstruction underwent segmentary ileal resection more often than other groups. Histopathology revealed inflammation in 26 (44%) specimens, ectopic tissue in 18 (31%) and necrosis in four (7%). Ectopic gastric mucosa was detected in 15 specimens, pancreatic tissue in two and both gastric and pancreatic tissue in one. CONCLUSIONS Symptomatic OMD remnants in children most commonly presented with GIT obstruction, acute abdomen and umbilical anomalies. Rectal bleeding was not a predominant finding in the present series. Surgery is curative and can safely be done either by way of wedge resection or ileal segmentary resection. Ectopic tissue is detected in approximately one third of symptomatic remnants.
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Affiliation(s)
- Cigdem Ulukaya Durakbasa
- Istanbul Goztepe Education and Research Hospital, Department of Pediatric Surgery, Istabul, Turkey.
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Laparoscopic treatment of mucinous urachal adenocarcinoma with mucocele. Surg Laparosc Endosc Percutan Tech 2009; 19:e26-8. [PMID: 19238053 DOI: 10.1097/sle.0b013e318196d033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present a case of an asymptomatic 76-year-old woman treated laparoscopically for an urachal mucocele owing to a nonmetastatic urachal mucinous adenocarcinoma. Since laparoscopic en bloc resection of the urachus and partial cystectomy, the patient has been healthy and disease-free for 12 months. Modern surgical treatment of urachal adenocarcinoma is discussed in the light of this case.
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Yapo BR, Gerges B, Holland AJA. Investigation and management of suspected urachal anomalies in children. Pediatr Surg Int 2008; 24:589-92. [PMID: 18357457 DOI: 10.1007/s00383-008-2136-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2008] [Indexed: 10/22/2022]
Abstract
Urachal anomalies occur infrequently, but may be associated with morbidity, particularly when the diagnosis has been delayed. We retrospectively reviewed our institution's experience over a 10-year and 7-month period in the investigation and management of suspected urachal anomalies. There were 25 children between November 1995 and June 2006, who presented with a suspected urachal anomaly. The mean age was 12 months (range 3 days to 13 years); 14 were male. Presentations included granulomatous polyp (16), umbilical discharge (4), umbilical sepsis (2) and abdominal pain (2). One case was diagnosed incidentally during a renal ultrasound scan (US). The main investigative tool was US (10), followed by micturating cystourethrogram (2). Of the 25 children, 12 had a patent urachus confirmed by subsequent further imaging or surgery. Our review suggests that whilst clinical examination remains important in the management of a child presenting with a possible urachal pathology, in 36% of the cases the correct diagnosis was only made with further radiological imaging or at operation. Surgical excision was effective with no morbidity or mortality.
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Affiliation(s)
- B R Yapo
- Department of Academic Surgery, The Children's Hospital at Westmead, The University of Sydney, Westmead, NSW, 2145, Australia
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Abstract
Primary ventral hernias can be congenital or acquired, but are not associated with a fascial scar or related to a trauma. Some ventral hernias such as Spigelian, lumbar, or obturator hernias represent a diagnostic challenge, given their relative rarity and their unusual anatomic locations. The article presents the etiology, clinical presentation, and diagnosis of these hernias, and briefly describes the various surgical approaches, including open and laparoscopic.
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