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Aim: This study aims to compare the efficacy and safety of topical application of common salt (CS) in comparison to silver nitrate (SN) for treating infants with umbilical granuloma (UG). Materials and Methods: We conducted an open-label, prospective, single-center, pilot randomized controlled trial. Thirty-seven infants with a clinical UG diagnosis were enrolled between October 2022 and July 2023, excluding those previously treated for UG. Patients were randomly assigned (using the Randomizer® app) to receive either topical CS (applied thrice daily by caregivers at home for 5 days) or SN (applied by pediatric surgeon in clinic and kept under occlusive dressing for 48 h). Patients with partial/no healing received an additional session of the same treatment. Nonresponders transitioned from CS to SN, and vice versa, for two more applications. Healing rates were compared with a significance level of α =0.05. Results: Out of 34 patients (18 CS and 16 SN), 32 successfully completed the trial (17 CS and 15 SN). No significant differences were observed in baseline characteristics. Efficacy rates of CS (19/22; 86.36%) and SN (11/17; 64.71%) did not significantly differ (P = 0.056; 95% confidence interval [CI] −0.4832–0.0502). No major adverse events were reported. CS showed superior healing outcomes in infants below 3 months of age (19/22; 86.36%) compared to SN (11/17; 64.71%) (P = 0.056; 95% CI − 0.4832–0.0502). The timing of umbilical cord detachment did not significantly affect healing rates. Conclusion: Widespread availability, ease of access, suitability for safe home application, and cost-effectiveness make CS a primary treatment option for UG. Larger patient cohorts are needed for conclusive results.

Objective: To compare the efficacy of table salt with silver nitrate in the treatment of umbilical granuloma presenting to the neonatal unit/paediatric department KTH. Study Design: Randomized Controlled Trial Setting: Neonatal Unit of Khyber Teaching Hospital. Period: November 2019 to November 2022. Methods: A total of 120 patients who presented to the neonatal unit/paediatric department, aged 15-60 days were enrolled in this study via consecutive sampling. Seventy-five patients each, were allocated to two groups, Group A (common salt) and Group B (silver nitrate). Sixteen patients from Group A whereas, in Group B, 17 patients were lost to follow-up. Results: A total of 58 out of the remaining 117 patients were female whereas 59 patients were male. Treatment response was recorded for both groups. The cure rate was greater among Group B (93%) as compared to Group A (88%) but there was no statistically significant difference between Group A and B in treatment response (p= 0.35). Conclusion: Table salt is a cheaper, easily accessible, and safe alternative to topical silver nitrate in the treatment of umbilical granuloma. [ABSTRACT FROM AUTHOR]

Aim: This study aims to compare the efficacy and safety of topical application of common salt (CS) in comparison to silver nitrate (SN) for treating infants with umbilical granuloma (UG). Materials and Methods: We conducted an open-label, prospective, single-center, pilot randomized controlled trial. Thirty-seven infants with a clinical UG diagnosis were enrolled between October 2022 and July 2023, excluding those previously treated for UG. Patients were randomly assigned (using the Randomizer® app) to receive either topical CS (applied thrice daily by caregivers at home for 5 days) or SN (applied by pediatric surgeon in clinic and kept under occlusive dressing for 48 h). Patients with partial/no healing received an additional session of the same treatment. Nonresponders transitioned from CS to SN, and vice versa, for two more applications. Healing rates were compared with a significance level of a =0.05. Results: Out of 34 patients (18 CS and 16 SN), 32 successfully completed the trial (17 CS and 15 SN). No significant differences were observed in baseline characteristics. Efficacy rates of CS (19/22; 86.36%) and SN (11/17; 64.71%) did not significantly differ (P = 0.056; 95% confidence interval [CI] -0.4832-0.0502). No major adverse events were reported. CS showed superior healing outcomes in infants below 3 months of age (19/22; 86.36%) compared to SN (11/17; 64.71%) (P = 0.056; 95% CI - 0.4832-0.0502). The timing of umbilical cord detachment did not significantly affect healing rates. Conclusion: Widespread availability, ease of access, suitability for safe home application, and cost-effectiveness make CS a primary treatment option for UG. Larger patient cohorts are needed for conclusive results. [ABSTRACT FROM AUTHOR]

Umbilical granuloma (UG) is a common problem during the neonatal period; however, its epidemiology and etiology are poorly studied, and the best treatment option has not yet been established. We examined the medical records of neonates who were born and underwent 1-month evaluations at our hospital between 2013 and 2022 to investigate the frequency of—and factors associated with—UG, as well as the annual trends of UG treatments and their efficacy. Of the 6680 eligible neonates, 395 (5.9%) had UG. The annual incidence rate ranged from 3.8% to 7.3%. Gestational age, birth weight, and incidence of meconium-stained amniotic fluid were significantly associated with UG. Silver nitrate cauterization was the predominant UG treatment from 2013 to 2016. Silver nitrate cauterization and topical betamethasone valerate were nearly equally applied in 2017. Betamethasone application became predominant in 2018. The healing rates during the initial treatment period were 91% for silver nitrate cauterization, 97.7% for betamethasone application, 60% for ethanol disinfection, and 88% for ligation; these rates were significantly different (p < 0.001). Topical steroid application may be the most effective treatment. If steroid application is ineffective, then silver nitrate cauterization and ligation may be important treatment options. [ABSTRACT FROM AUTHOR]

Common salt is a safe, effective and cheap home-made remedy for umbilical granuloma. The aim of this scoping review is to identify and summarize the available evidence and examine the research conducted on salt treatment for umbilical granuloma. A literature search was performed in the second week of September, 2022 using Google scholar, PubMed, MEDLINE and EMBASE databases using the keywords 'umbilical granuloma' and 'salt treatment' to identify all English articles pertaining to salt treatment for umbilical granuloma. Tables were made to summarize the methodological characteristics, results and the dosage regimens of salt used by different authors. The Cochrane Collaboration's tool was used for assessing risk of bias in RCTs. The indexing statuses of the journals publishing these studies were also noted. The overall efficacy with the use of common salt was calculated by adding the success rates mentioned in each study. Twenty-four articles (2 systematic reviews, 6 Randomized Controlled Trials, 11 prospective cohort studies, 1 case control study, 3 retrospective case series and 1 case report) were included. An overall 93.91% success rate (1033/1100) was seen with common salt application, without any reports of complications/recurrences. Topical application of common salt for umbilical granulomas is simple, effective and inexpensive. This scoping review provides a broader outlook at the existing level of evidence and may help in planning interventional comparative studies, so that recommendations can be formulated. It also highlights a lack of properly designed randomized controlled trials on this topic. I. [ABSTRACT FROM AUTHOR]

Background: Umbilical granuloma (UG) and umbilical polyps (UPs) are the most common umbilical abnormalities in neonates, causing inflammation and drainage. Aims: The aim of this study was to compare the effectiveness of the technique of silver nitrate cauterization and surgical excision on both UG and UP in pediatric patients. Settings and Design: A prospective study on UG and UP was carried out in a high-volume tertiary care teaching institute from January 2015 to December 2020. Materials and Methods: The patients were randomly distributed by chit method into two groups: Group A treated with surgical excision and Group B treated with silver nitrate cauterization. Statistical Analysis: The unpaired Student's t-test was used to find the existence of any statistical significance between the parameters of the two groups. Results: There were 105 patients with 59 males and 46 females. There were 70 patients in Group A and 35 in Group B. Most of the patients in both Group A and Group B were between >1 and 3 months of age group. Blood mixed umbilical discharge was the most common complaint. There was complete resolution of symptoms in 100% of patients in Group A. In Group B, success with first attempt with cauterization was achieved in 20 (57.14%) patients and 12 (34.29%) patients after the second attempt. In Group B, successful management was achieved in 2 (5.71%) patients after the third attempt combined with double ligation. In 1 (2.86%) patient, there was an incomplete response to cauterization. Minimal perilesional burn (in the umbilicus) was observed in four cases, two each in the UG and UP groups. Conclusions: The technique of silver nitrate cauterization for both UG and UP is a simple, less expensive, and safe procedure in experienced hands. Most patients show complete responses at the first attempt. In others, complete resolution is accomplished at the second or third attempt. Surgical excision should be performed in cases with an incomplete response and larger lesions.

Introduction: Following the adoption of home based, table salt treatment for Umbilical granuloma in our practice, we observed that there was a paucity of report on the use of table salt for the treatment of Umbilical granuloma in African children. We report the outcome of treatment of eight children treated with Table salt in our facility. Methods: We carried out a retrospective review of the medical records of infants who were diagnosed with umbilical granuloma and were managed using table salt in our hospital in 2016 and 2020. Additional data about diagnosis, treatment and outcome were extracted from records of electronic communications via emails and WhatsApp® between the Paediatrician and caregivers of these infants. Written informed consent of caregivers of the infants were obtained and the study received approval of the Research and Ethics Committee of our Hospital. Results: Nine infants were diagnosed with Umbilical granuloma during the study period but informed consent was obtained for eight of them. All eight children (100%) treated with table salt had resolution of umbilical granuloma confirmed at the end of the treatment period without any adverse event. Conclusion: Home based, Table salt treatment was found to be safe and effective treatment for umbilical granulomas among the children treated in our facility.

Aim: This study aimed to compare the efficacy of 3% versus 30% NaCl solution in treating umbilical granuloma (UG) and to evaluate parental satisfaction. Methods: A randomised, double‐blinded, comparative study in neonates with UG was conducted. Stratified, block‐of‐four randomisation was used to allocate neonates into two groups, treated with 3% or 30% pharmaceutical‐grade NaCl solution, three times daily. The time to resolution was determined by daily photographs of UG and weekly hospital visits. If there was no response after 2 weeks, silver nitrate was used. Parental satisfaction was measured on a rating scale of 1–5. Results: One hundred neonates were enrolled, 48 in the 3% NaCl group and 52 in the 30% NaCl group. Baseline demographic data were not different between the groups. There was no significant difference in the resolution rate (93.8% vs 98.1%) or the median (interquartile range) time to resolution (7 (5–13) vs 7 (4–11) days) between the 3% and 30% NaCl groups, respectively. No skin burn or cellulitis was detected. About 95% of parents scored >4 for satisfaction. Conclusions: Hypertonic NaCl solution is highly effective in treating UG without side effects. Hypertonic NaCl solution should be considered as an alternative treatment for UG. [ABSTRACT FROM AUTHOR]

Purpose The sonographic differential diagnosis of umbilical polyps and granulomas in children based on correlations with pathologic findings. Methods We retrospectively analyzed the ultrasonographic findings of twenty-two umbilical masses in children that were pathologically confirmed as umbilical polyps or umbilical granulomas by surgery. We analyzed size, depth, echogenicity, internal content, intralesional vascularity, and the presence of unobliterated medial umbilical ligament. Pathologic correlation was performed for all of the umbilical masses. Results Twenty-two masses consisted of eight umbilical polyps and fourteen umbilical granulomas. The mean age of the children with umbilical polyps was 30.13 months (range, 2 to 108 months) and it was 1.33 months (range, 0.6 to 3 months) for the children with umbilical granulomas. The average mass sizes were 10.25 mm (range, 5 to 35 mm) for umbilical polyps and 6.21 mm (range, 3 to 10 mm) for umbilical granulomas. The umbilical polyps were manifested as cystic lesions with thick echogenic walls in five patients (62.5%), which were associated with the intestinal mucosa (four lesions) and ectopic pancreatic tissue (one lesion) on pathology. Umbilical granulomas were superficially located in 13 (92.9%) and solid in thirteen (92.9%), which correlated with prominent granulation tissues on pathology. Seven (87.5%) of the eight umbilical granulomas were hypervascular and correlated with neovascularization on pathologic examination. Conclusion The umbilical polyps revealed deep-seated, hypovascular nodules with cyst formation surrounded by thick echogenic walls. In contrast, the umbilical granulomas revealed superficially located hypervascular hypoechoic solid nodules in young infants.

Background: Umbilical granuloma (UG) and umbilical polyps (UPs) are the most common umbilical abnormalities in neonates, causing inflammation and drainage. Aims: The aim of this study was to compare the effectiveness of the technique of silver nitrate cauterization and surgical excision on both UG and UP in pediatric patients. Settings and Design: A prospective study on UG and UP was carried out in a high-volume tertiary care teaching institute from January 2015 to December 2020. Materials and Methods: The patients were randomly distributed by chit method into two groups: Group A treated with surgical excision and Group B treated with silver nitrate cauterization. Statistical Analysis: The unpaired Student's t-test was used to find the existence of any statistical significance between the parameters of the two groups. Results: There were 105 patients with 59 males and 46 females. There were 70 patients in Group A and 35 in Group B. Most of the patients in both Group A and Group B were between >1 and 3 months of age group. Blood mixed umbilical discharge was the most common complaint. There was complete resolution of symptoms in 100% of patients in Group A. In Group B, success with first attempt with cauterization was achieved in 20 (57.14%) patients and 12 (34.29%) patients after the second attempt. In Group B, successful management was achieved in 2 (5.71%) patients after the third attempt combined with double ligation. In 1 (2.86%) patient, there was an incomplete response to cauterization. Minimal perilesional burn (in the umbilicus) was observed in four cases, two each in the UG and UP groups. Conclusions: The technique of silver nitrate cauterization for both UG and UP is a simple, less expensive, and safe procedure in experienced hands. Most patients show complete responses at the first attempt. In others, complete resolution is accomplished at the second or third attempt. Surgical excision should be performed in cases with an incomplete response and larger lesions. [ABSTRACT FROM AUTHOR]

Omphalomesenteric duct remnant, umbilical granuloma, umbilical heterotopic gastrointestinal tissue, umbilical heterotopic gastric mucosa, umbilical polyp Keywords: omphalomesenteric duct remnant; umbilical granuloma; umbilical heterotopic gastric mucosa; umbilical heterotopic gastrointestinal tissue; umbilical polyp EN omphalomesenteric duct remnant umbilical granuloma umbilical heterotopic gastric mucosa umbilical heterotopic gastrointestinal tissue umbilical polyp 379 381 3 03/31/23 20230301 NES 230301 CASE PRESENTATION A healthy 18-month-old boy presented with a red umbilical lesion present since birth. Clinically, superficial OMD remnants are often indistinguishable from umbilical granulomas and no reliable distinguishing physical characteristics have been identified.[7] Umbilical polyps form via outward telescoping of OMD mucosa, while OMD cysts occur when a portion of OMD remains patent and the ends obliterate. [Extracted from the article]

• Umbilical granuloma responds well to both chemical catherization via copper sulphate treatment and osmotic dehydration via table salt application. • Our study shows that table salt is associated with a significantly higher rate of lesion resolution compared to copper sulphate. • There were no complications reported with the use of table salt, compared to 9% of infants who had superficial skin burns after copper sulphate application. Umbilical granuloma is a common infantile condition which usually responds to non operative management. Copper sulphate (CuSO 4) is often used as chemical cauterization but can cause superficial skin burns. An alternative is table salt (NaCl), which osmotically dehydrates wet granulation tissue causing necrosis. We aimed to compare the effectiveness of NaCl versus CuSO 4 in treating umbilical granuloma. We performed a multi centerrandomized controlled trial involving three regional pediatricsurgical units. We included children who presented with umbilical granuloma from December 2018 to May 2020. Children who received treatment prior to index visit were excluded. They were randomly allocated to receive NaCl (twice/day application for 5 days by caregiver) or CuSO 4 (single application by clinician). Demographic data, compliance in the NaCl group by pill counting method, treatment outcomes, and complications were recorded. Treatment success was defined as complete lesion resolution. Partial or no response was considered treatment failure. Subsequent treatment then reverted to the respective center's routine management. We recruited 70 participants with 6 dropouts (2 defaulters, 1 vitellointestinal duct, 3 urachal remnants), leaving 64 subjects for final analysis: 31 NaCl, 33 CuSO 4. Compliance rate of 77.4% was recorded for NaCl, with 6 (20%) 'poor compliance' participants stopping therapy before completion owing to complete resolution. NaCl group had a significantly higher complete resolution rate (90.4%) compared to CuSO 4 (69.7%), p = 0.040. No NaCl participant developed complications versus 9% (n = 3) in CuSO 4 (periumbilical superficial skin burn). Table salt is an ideal treatment choice for umbilical granuloma as it is effective, safe, and readily available. II. [ABSTRACT FROM AUTHOR]

An umbilical granuloma is a most common umbilical abnormality in neonates which occurs due to overgrowth of umbilical tissue during the healing process. In Ayurveda, umbilical granuloma can be correlated with conditions like Pindalika(one of the complication of improper cutting of umbilical cord) or NabhigataArsha(extra growth on umbilicus). Aneight-years-old male child presented with a complaint of reddish swelling on umbilicus with discharge and occasional bleeding from umbilicus sincebirth. On examination a single swelling on umbilicus measuring 1 × 0.8 × 0.5 cm, cherry red in color with serous discharge was present. It was soft, non-tender and moist. Surrounding skin was occupied with unhealthy accumulation of chronic discharges.Under aseptic precautions, Apamarga Pratisaraneeya Kshara (alkaline preparation having Achyranthes aspera plant) was applied on the umbilical granuloma. This treatment procedure was repeated for next two days. At seventh day from the first day of the Kshar application, it was completely healed. Umbilical granuloma was successfully treated with Kshara Karma.

Introduction: Umbilical granuloma is a widespread problem that may cause anguish to the parents. Patients and method: A randomized controlled study was conducted on 85 neonates aged 2-4 weeks (42 males and 43 females) with a diagnosis of umbilical granuloma. They were randomly divided into 2 groups; group A included 42 patients (20 males and 22 females), and group B included 43 patients (21 males and 22 females). Parents of group A patients were instructed to use a small amount of common salt on the granuloma after cleaning it, and to cover the salt by blaster for 30 minutes to keep it in place; after that, the blaster had to be removed, and the umbilicus was cleaned with sterile cotton and water to remove the salt. The procedure was repeated for 3 days straight. Group B was treated once by applying clean dry silver nitrate sticks (concentration of 20%) on the granuloma; contact with normal skin was avoided. The procedure was performed by the researcher himself at his clinic. Statistical analysis was done by using Fisher Exact test. Results: In group A, 39 (92.9%) responded to treatment by salt, while 3 (7.1%) of them did not respond. In group B, 41 (95.3%) responded to treatment by silver nitrate, while 2 (4.7%) did not respond. There was no significant difference between the two groups, with p-value = 0.676. Conclusion: Umbilical granuloma can be treated with topical application of common salt; such a method can be considered a valid alternative for its effectiveness, safety, and simplicity.

Umbilical granuloma is a common umbilical problem in infants. Although various modalities are available for the treatment of umbilical granulomas, the best method remains controversial. A seven week old infant presented with umbilical granuloma with features of omphalitis. We treated the omphalitis first to prevent local inflammation. On the following day, the umbilical granuloma was successfully cut off with a nylon suture thread. No residue of the granuloma was left behind and no signs of local inflammation appeared. Umbilical granuloma can be successfully removed with a nylon suture thread. Treatment for omphalitis before granuloma removal may be useful to prevent local inflammation. [ABSTRACT FROM AUTHOR]

The urachus, an embryonic organ associated with the bladder, typically undergoes degeneration shortly after birth. Inadequate closure of the urachus can result in urachal malformations, with the most common being a urachal cyst. Failure to promptly identify and address this condition can lead to complications such as sepsis, fistula development, and cyst rupture, mimicking symptoms of peritonitis. Therefore, maintaining a heightened level of suspicion is crucial for timely diagnosis and effective management of urachal cysts, particularly in emergency room settings. We present the case of a 24-year-old male who exhibited clinical signs consistent with an acute abdomen. The use of imaging techniques confirmed the presence of an infected urachal cyst, which was successfully treated through surgical intervention., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Watkins-Granville et al.)

Background: Alcohol, antibiotic ointments, silver nitrate and ligation had been presented for treatment of umbilical granuloma. Salt powder due to its hyper osmolarity effects can induce drying and necrosis of granuloma tissue. Present parallel single blind randomized clinical trial was performed in neonates of shahvali hospital for assessment of salt powder in management of umbilical granuloma. Patients and Methods: Present parallel single blinded randomized clinical trial was performed on 60 neonates with umbilical granuloma between January and October 2015. Our samples were selected randomly from neonates with healthy umbilical granuloma. Neonates in case group, salt powder was prescribed in five days (30 minutes two times per day) and located on the umbilical granuloma. During these five days neonates in control group were only clinically examined. Complete removal of umbilical granuloma was considered as study outcome. Results: Umbilical granuloma removed in all neonates of case group who were treated with salt powder but in control group, only four neonates had complete granuloma removing. Recovery rate had significant difference between two trial groups (p=0.00). Conclusion: Management of umbilical granuloma with salt powder in neonates had suitable therapeutic effects in comparison with other methods without any complications.

Introduction: The most common umbilical disorders in infants is umbilical granuloma. To date, various therapeutic methods have been proposed to treat umbilical granuloma. This study aimed to compare the clinical results of salt therapy with surgery in the treatment of umbilical granuloma in infants. Materials and Methods: In a clinical trial study, 50 infants with umbilical granuloma visited at the Children Educational-Medical Hospital of Tabriz University of Medical Sciences were selected and randomly allocated into two groups. In the first group, 25 patients were treated with sterile salt, and in the second group; 25 patients underwent surgery using electro cauterization. Patients were followed for three months, and the cure rate, relapse rate, and side effects of each method were evaluated. Results: Results showed that cure rate in the salt therapy group was 96.0% but in the surgery group it was 100%. There was no statistically significant difference between the two group regarding the cure rate (p=1.000). No relapse or side effects were seen in any of the study groups. Conclusion: Based on the findings of the present study, salt therapy is a safe and effective method in the treatment of umbilical granuloma which can be an alternative to surgical methods in this regard.

Umbilical granuloma is a benign growth composed of granulation tissue at the base of umbilicus presents as red, soft, moist and friable lump at umbilicus. Objectives: Objective of our study is to evaluate the therapeutic role of table salt in umbilical granuloma in infants. Study Design: A Prospective Interventional Study. Setting: Outpatient Department of Pediatric Surgery, Bacha Khan Medical Complex (BKMC) Swabi. Period: Seventeen months (from 1st October 2017 to 31st March 2019). Material & Methods: First 66 consecutive fit infant were included in the study. Parents of infants were taught to apply a pinch of table salt on umbilical granuloma after cleaning with warm water. A dressing was applied over umbilicus for 30 minutes for the table salt to remain on granuloma and granuloma washed again with warm water. Parents’ learning was assured and they were advised to repeat the procedure twice a day for consecutive five days. Parents were counseled to bring their infants for follow up at end of week and then after completion of three weeks. Result: Out of 66 infants, 30 were male and 36 were female. We observed complete resolution of granuloma in all infants except one that turned out umbilical polyp and was excised under general anesthesia. Conclusion: Treatment of umbilical granuloma with table salt is safe, simple and very economical. [ABSTRACT FROM AUTHOR]

Background: Elective repair of an umbilical hernia is one of the most common surgical operations performed by pediatric surgeons, although most of them resolve spontaneously during the first 3 years of life. The exact technique and steps involved in the repair differ widely among pediatric surgeons. Many pediatric surgeons prefer the transverse interrupted suture technique in rectus sheath closure than the purse string or continuous technique as it isolates the tension to each individual stitch, ensures correct suture placement and precise coaptation of edges. It is less likely to devascularize the incision margin. Interrupted sutures also have the advantage that they can be removed individually if infection or haematoma formed, while the purse string suture or the continuous closure has the disadvantage of being a single suture line holding the fascia together and most of wound dehiscence occurs because sutures cut through the fascia. In this study we give a chance to assess the efficacy of the purse string technique. Objective: The aim of our study is to compare between umbilical hernia repair of rectus sheath with closure by interrupted sutures and purse string technique regarding operative time, intra operative complications (bleeding, intestinal injury), and post-operative complications (edema, hematoma formation, seroma formation, cosmetic appearance & recurrence). Materials & Methods: A total of 30 umbilical hernias in children (17 females and 13 males) were operated in Ain Shams University hospital and El Galaa teaching hospital from September 2017 till May 2018. Results: In this prospective study, 30 cases of umbilical hernia in children aging from two years till the age of ten years including 17 female and 13 male with a ratio of 1.3: 1 were randomly selected from the outpatient clinic of Ain Shams University hospital and Al Galaa teaching hospital were divided into two equal groups, group A underwent the repair of the rectal sheath with purse string suture technique while group B underwent the repair with transverse interrupted suture technique. Conclusion: Conclusively, there are no significant differences between both techniques regarding the intra operative complications and post operative complications in short term follow up; however, transverse interrupted suture technique appears to consume more time than the purse string technique. [ABSTRACT FROM AUTHOR]

The umbilicus is involved in a wide range of abnormalities in infants and children. The most severe are evident at birth and include exomphalos (omphalocele) and gastroschisis, both of which can be life-threatening but are easy to diagnose. Exomphalos is often associated with other congenital abnormalities, whereas the associated problems in gastroschisis are largely confined to the gut. Infection of the umbilicus in the neonate presents as omphalitis. The causes of a moist umbilicus following separation of the umbilical stump are multiple, from the relatively minor umbilical granuloma or ectopic bowel mucosa to the more significant patent urachus that leaks urine. Patency of the entire vitello-intestinal (omphalomesenteric) tract allows air and faecal fluid to drain through the umbilicus. The clinical manifestations of persistence of the vitello-intestinal tract vary markedly according to which part remains: clinical presentations include melaena and anaemia, closed-loop bowel obstruction and Meckel diverticulitis. An umbilical hernia occurs when the umbilical cicatrix fails to close. On the other hand, the umbilicus has its uses, which range from being a route for intravenous access in the neonate to being a convenient point of access in laparoscopic surgery. [ABSTRACT FROM AUTHOR]

Patent urachus with patent vitellointestinal duct is a rare combination to present in the same patient. We present a rare case of one year old male child with such a condition presenting with complaint of discharge from umblicus along with severe anaemia and an umblical granuloma. On exploratory laparotomy, patent tracts joining umblicus to ileum and umblicus to apex of urinary bladder were found. Both the tracts were excised and appropriate closure was done. Patient had been under follow up and is doing well.

Background: Although lesions of umbilicus are encountered in clinical practice on a regular basis, surgical intervention is rarely required for them. Umbilical tissues are uncommonly received for histopathology. They formed 0.18% of the total specimens received. Aims: To study the clinical and histopathological characteristics of umbilical lesions received in the Surgical Pathology Department of a tertiary care hospital. Materials and Methods: This is a 2-year retrospective study. Records of the cases were reviewed and the histopathology slides were reassessed. Results: A total of 15 cases were found between the age range of 9 months and 45 years, with a male preponderance. Complaints of umbilical discharge/wet umbilicus and umbilical mass were the most common. In four cases, the umbilical lesion was associated with underlying congenital anomaly. Umbilical sinus (four cases) and umbilical granuloma (three cases) were the most common histopathological diagnosis. Two of the sinuses were pilonidal sinuses, which are rare lesions in this location. Conclusion: Umbilical mass or discharge associated with abdominal symptoms requires careful evaluation for congenital anomalies. Pilonidal sinus should be considered in a young hirsute patient with wet umbilicus.

Background: Umbilical cord hernia is an uncommon umbilical anomaly which develops during 10th to 12th weeks of gestational age owing to failure of complete bowel return into coelomic cavity. In extremely rare cases appendix is the only trapped organ in hernia sac which may erode the overlying membrane and simulate umbilical granuloma. Case Report: Two infants presented with delayed umbilical cord separation with a reddish mass at umbilicus which was initially diagnosed as umbilical granuloma. Surgical exploration on failure of conservative measures revealed it as vermiform appendix. Appendectomy was done in both cases. Conclusion: Vermiform appendix at umbilicus is a rare congenital anomaly and may simulate other pathologies at umbilicus. [ABSTRACT FROM AUTHOR]

Résumé L’embryologie permet de comprendre les anomalies du cordon qui touchent les vaisseaux sanguins, le canal omphalo-mésentérique et l’ouraque. Les mécanismes en jeu dans la chute du cordon et de la cicatrisation des plaies permettent de comprendre la pathologie de l’ombilic. La hernie du cordon est une forme mineure d’omphalocèle. Un écoulement peut être dû à une inflammation, une infection ou à une fistule digestive ou ouraquienne. Ces 2 types de reliquats peuvent avoir un aspect pseudo-tumoral. Omphalites et morbidité infectieuse du premier mois dépendent de la qualité de l’hygiène de l’ombilic qui reste difficile à appréhender et doit s’adapter à l’environnement parental. Le traitement du granulome n’a pas fait ses preuves. Au-delà de 45 jours, la persistance du cordon fait rechercher une neutropénie ou un déficit de la phagocytose. Summary The embryologic development explains the umbilical abnormalities as number of artery and aspect, omphalomesenteric or allantoic ducts remnants. Mechanisms of umbilical cord separation and skin healing explain the umbilical secondary problems. Umbilical hernia is a minor coelosomia. Mild secretions can be due to inflammation, infection, omphalomesenteric allantoic ducts remnants. These remnants can look like tumors. Omphalitis and neonatal sepsis depend on topical cord care that remains unclear (antiseptic or not) but must be based on family knowledge and environment. The treatment of granuloma is unclear. Looking for neutropenia or phagocytosis abnormality is necessary if umbilical cord separation happens after 45 days of life. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Prenatally, the umbilicus is of paramount importance, providing the gateway between the mother and the fetus. As the fetus becomes increasingly autonomous at the end of the second month of fetal life, the connections (vitelline, urachal) diminish in significance and involute. Disturbances in this process can result in a wide variety of abnormalities, ranging from relatively minor defects identified at birth (umbilical granulation tissue) to life-threatening complications quiescent until late adulthood (urachal carcinoma). This section will review the ‘state of the art’ in evaluation and management of these umbilical and related abnormalities. [Copyright &y& Elsevier]