weekly_question 26/9/2021

[Admin]

A three month old baby is referred from their pediatrician with persistent drainage from the umbilicus despite silver nitrate cauterizations. The most common cause of a "wet umbilicus" in the neonate is

A omphalomesenteric duct remnant

B patent urachus

C umbilical granuloma

D urachal sinus

E ectopic mucosa

[Admin]

correct answer
C umbilical granuloma

The “wet umbilicus” in the neonate is usually a result of an umbilical granuloma or cord remnant and does not warrant an extensive work up. There is often associated minor erythema and excoriation of the surrounding periumbilical skin. In most cases, the umbilical granuloma can be treated with silver nitrate applications, taking care to protect the surrounding skin from any chemical burn.

Significant drainage, particularly if it resembles intestinal contents or urine would suggest the possibility of omphalomesenteric (vitelline) or urachal remnants. In this case, an ultrasound should be obtained. Occasionally, as in the case of an obvious mucosal opening within the umbilicus, sinography using a lateral radiograph may be diagnostic. Cystogram is usually unnecessary and should be avoided unless there is suspicion of posterior urethral valves in a boy where the patent urachus may be the only egress for urine.

If the umbilical wetness or draining mass persists after several silver nitrate applications and the imaging is nondiagnostic , local excision of the umbilical granuloma, polyp, sinus tract or ectopic mucosa may be necessary.

[Mohamed ahmed Abd elsalam]

C

[Bassam Kh Al-Abbasi]

The most common cause is granuloma so, the correct answer is C , but if failed to resolve after cauterization other conditions like POM , or urachus should be suspected?

[Sulthana Dhilras J]

A) omphalomesenteric duct remnant

[Mumtaz]

A is best answer. option C & E is also Omphalomesenteric remnant.
urachal anomalies (B&D) are less common.

[Admin]

correct answer
C umbilical granuloma

The “wet umbilicus” in the neonate is usually a result of an umbilical granuloma or cord remnant and does not warrant an extensive work up. There is often associated minor erythema and excoriation of the surrounding periumbilical skin. In most cases, the umbilical granuloma can be treated with silver nitrate applications, taking care to protect the surrounding skin from any chemical burn.

Significant drainage, particularly if it resembles intestinal contents or urine would suggest the possibility of omphalomesenteric (vitelline) or urachal remnants. In this case, an ultrasound should be obtained. Occasionally, as in the case of an obvious mucosal opening within the umbilicus, sinography using a lateral radiograph may be diagnostic. Cystogram is usually unnecessary and should be avoided unless there is suspicion of posterior urethral valves in a boy where the patent urachus may be the only egress for urine.

If the umbilical wetness or draining mass persists after several silver nitrate applications and the imaging is nondiagnostic , local excision of the umbilical granuloma, polyp, sinus tract or ectopic mucosa may be necessary.