Book - Umbilicus (1916) 13

From Embryology
Embryology - 16 Sep 2019    Facebook link Pinterest link Twitter link  Expand to Translate  
Google Translate - select your language from the list shown below (this will open a new external page)

العربية | català | 中文 | 中國傳統的 | français | Deutsche | עִברִית | हिंदी | bahasa Indonesia | italiano | 日本語 | 한국어 | မြန်မာ | Pilipino | Polskie | português | ਪੰਜਾਬੀ ਦੇ | Română | русский | Español | Swahili | Svensk | ไทย | Türkçe | اردو | ייִדיש | Tiếng Việt    These external translations are automated and may not be accurate. (More? About Translations)

Cullen TS. Embryology, anatomy, and diseases of the umbilicus together with diseases of the urachus. (1916) W. B. Saunders Company, Philadelphia And London.

Umbilicus (1916): 1 Umbilical Region Embryology | 2 Umbilical Region Anatomy | 3 Umbilical New-born Infections | 4 Umbilical Hemorrhage | 5 Umbilicus Granuloma | 6 Omphalomesenteric Duct Remnants | 7 Umbilicus Abnormalities | 8 Meckel's Diverticulum | 9 Intestinal Cysts | 10 Patent Omphalomesenteric Duct 1 | 11 Patent Omphalomesenteric Duct 2 | 12 Bowel Prolapsus at Patent Omphalomesenteric Duct | 13 Abdominal Wall Cysts by Omphalomesenteric Duct Remnants | 14 Omphalomesenteric Vessels Persistence | 15 Umbilical Inflammatory Changes | 16 Subumbilical Space Abscess | 17 Umbilicus Paget's Disease | 18 Umbilicus Infections | 19 Umbilicus Abnormalities 2 | 20 Umbilicus Fecal Fistula | 21 Umbilicus Round Worms | 22 Umbilicus Foreign Substance Escape | 23 Umbilical Tumors | 24 Umbilicus Adenomyoma | 25 Umbilicus Carcinoma | 26 Umbilicus Sarcoma | 27 Umbilical Hernia | 28 The Urachus | 29 Congenital Patent Urachus | 30 Urachus Remnants | 31 Urachal Remnants Producing Tumors | 32 Large Urachal Cysts | 33 Anterior Abdominal Wall Abscesses | 34 Urachal Cavities | 35 Umbilicus Acquired Urinary Fistula | 36 Urachal Concretions and Urinary Calculi | 37 Urachus Malignant Changes | 38 Urachus Bleeding into the Bladder | 39 Patent Urachus Tuberculosis | Figures
Historic Disclaimer - information about historic embryology pages 
Mark Hill.jpg
Pages where the terms "Historic Textbook" and "Historic Embryology" appear on this site, and sections within pages where this disclaimer appears, indicate that the content and scientific understanding are specific to the time of publication. This means that while some scientific descriptions are still accurate, the terminology and interpretation of the developmental mechanisms reflect the understanding at the time of original publication and those of the preceding periods, these terms and interpretations may not reflect our current scientific understanding.     (More? Embryology History | Historic Embryology Papers)

Chapter XIII. Cysts in the Abdominal Wall due to Remnants of the Omphalomesenteric Duct

Historic sketch.

Cysts developing between the peritoneum and muscles.

Subcutaneous cysts.

Report of cases.

Wtss and Colmers have each reported a case in which a small cyst was found lying between the peritoneum and the abdominal muscles. Zumwinkel observed a cyst lying external to the abdominal muscle.

Wyss's cyst was the size of a bean; Colmers' was as large as a hen's egg and divided into two cavities; Zumwinkel's was the size of a cherry-stone.

As will be noted from the histories, in each case the inner surface of the cyst at some point was lined with cylindric epithelium, and in Colmers' and Zumwinkel's



Fig. 142. — A Small Cyst of the Umbilicus Due to a Remnant of the Omphalomesenteric Duct. This is a schematic representation of a small cystic remnant of the omphalomesenteric duct lying just external to the peritoneum and communicating with the umbilicus. Passing from it to the bowel is a fibrous remnant of an omphalomesenteric vessel.



Fig. 143. — Small Cyst of the Abdominal Wall due to a Remnant of the Omphalomesenteric Duct. In rare instances a small cyst may be found in the abdominal wall in the umbilical region. This cyst is lined with a mucosa resembling to a more or less marked degree intestinal mucosa. This is a schematic representation of such a cyst.


cases Lieberkiihn's glands were demonstrable. In these two cases the walls of the cyst also contained non-striped muscle.

In Zumwinkel's case the cyst was connected with the umbilicus by a fine opening, and in Colmers' case the patent omphalomesenteric vessels were still present in the cord passing from the cyst to the umbilicus. These cysts, without a doubt, were due to remnants of the omphalomesenteric duct.

In Figs. 142 and 143 we have schematic representations of cysts developing just externally to the peritoneum and in the umbilicus itself.

A Small Cyst Between the Peritoneum and Muscle, Probably Remains of the Omphalomesenteric Duct.* — At autopsy, about an inch above the umbilicus and a little to the side of the linea

  • Wyss, Hans v.: Zur Kenntnis der heterologen Flimmercysten. Virchows Arch., 1870,

li, 143.

238


CYSTS IN THE ABDOMINAL WALL. 239

alba, Wyss found a cyst, the size of a bean, between the muscle and peritoneum. This contained turbid and tenacious mucus, which was grayish yellow in color. The cyst was lined with cylindric, ciliated epithelium, an epithelium that had undergone colloid change. Wyss thought the cyst might represent embryonic remains. The findings strongly suggest remains of the omphalomesenteric duct.

An Enterocystoma Developing Between the Peritoneum and the Recti Muscles. — Colmers* considers enterocystoma of the abdominal wall, but before giving his own case, mentions those reported by v. Wyss, Roser, and Schaad.

Colmers, in 1903, saw Frau K. 0., aged forty-six. She had always been healthy and was the mother of 12 children. Her illness commenced in the summer of 1903. In August she noticed that every movement of the body excited pain in the abdomen. No further trouble was noted until October, when there were digestive disturbances. When admitted to the hospital (November 17th) the woman was fairly well nourished, but the skin was pale. The abdomen was firm. On careful palpation an indefinite resistance could be felt around the umbilicus. The mass was the size of an egg, firm in consistence, and very movable.

Operation. — When the abdomen was opened, a fluctuating tumor, the size of a small hen's egg, was found in the umbilical region. It was attached to the abdominal peritoneum and partly nipped off from a small one about the size of a hazel-nut. This was also in the abdominal wall. Passing from the tumor to the umbilicus was a short, thick cord. The tumor was dissected out of the abdominal wall without difficulty. The stomach, intestine, and mesentery, as well as the uterus and adnexa, were normal. A somewhat enlarged gland from the greater curvature of the stomach was removed. This, on histologic examination, showed a simple hyperplasia. The extirpated tumor lay between the peritoneum and the sheath of the rectus. With the latter it had formed a broad adhesion.

The tumor contained a thick yellowish fluid, which had colorless masses, resembling mucus, scattered through it. The fluid contained numerous fat-droplets, many cholesterin crystals and fatty acid needles, as well as cells closely resembling fatty epithelium. The walls of the large cyst had on the inner surface numerous calcareous particles. These were attached to the wall or lay free in the cyst cavity. The wall of the portion of the cyst lying beneath the peritoneum was not over 0.2 mm. in thickness, and in places only 0.1 mm. thick. Near it were little bays or depressions running out in various directions. Here the walls reached a thickness of 0.5 mm.

These cysts communicated with each other by a small opening through which a sound could pass. The cord extending from the small cyst to the umbilicus appeared to be solid. The free walls of the cyst, that is, the portion lying beneath the peritoneum, contained connective tissue, in the inner layers of which calcareous deposits were found. No epithelial lining could be detected.

The small cyst was similar to the larger one. Here, however, the calcareous deposit was not marked. At one point at the base of the cyst were two small bays. These communicated with the main cyst by a small opening. The two small cysts, as indicated in Fig. 144, a, b, were lined with a beautiful, very high cylindric epithelium. This contained definite Lieberkuhn's glands, although

  • Colmers, F. : Die Enterokystome und ihre chirurgische Bedeutung. Arch. f. klin. Chir.,

1906, lxxix, 132.


240 THE UMBILICUS AND ITS DISEASES.

these were low and often irregular. Sometimes papillae were found projecting into the lumen of the cyst. This glandular layer covered a definite muscularis mucosae in which bands of smooth muscle-fiber were seen. The glands were not regular. but in some places they were arranged at right angles to one another. At a few points there were evidences of Auerbach's plexus.

The cord passing from the small cyst contained the omphalomesenteric vessels. Two of them had remained open and were surrounded by smooth muscle-fibers. The diagnosis was not difficult. The cysts had developed from remains of the omphalomesenteric duct.

A Subcutaneous Cyst Originating From the Omphalomesenteric Duct.*- — ■ The patient was a child seven years old. Since birth there had been a small opening at the umbilicus, which secreted a slimy fluid. In the right abdominal wall in the umbilical region was a roundish, ulcerated, hard


'-^i--' ^A





Fig. 144. — A Small Intestinal Ctst Lying Between the Peritoneum and the Recti. (After Colmers.) This picture represents one of the small bays running off from the large cyst, and communicating with it by a fine opening. At a we have Lieberkuhn's glands, some with well-developed papillary folds. The cyst space (6) in some places is lined with mucosa. At other places the epithelium is somewhat flattened or has disappeared completely. Surrounding the glands is non-striped muscle cut longitudinally and transversely.

nodule, 1.25 cm. in diameter. In the middle was a fine opening through which a sound could be passed 1 cm. into a cavity.

At operation a cyst the size of a cherry-stone was found. This was round, bluish in color, and easily loosened by blunt dissection from the underlying tissue.

The inner surface of the cyst was lined with cylindric epithelium, intestinal folds, and Lieberkuhn's glands. Outside of this was a muscular zone. In some places this was cut lengthwise; at others, transversely. It consisted of two layers. The mucosa was not normal. The folds or papillae were high and broad, and sometimes had several projections, suggesting a papilloma. The glands were more abundant. The muscle was especially thick. At only one point did the sac show normal mucosa.

The squamous epithelium in the vicinity of the cyst was increased in thicknessIn some places it was ten times as thick as normal. The papillae of the skin were also much lengthened.

  • Zumwinkel: Subcutane Dottergangscyste des Xabels. Langenbeek's Arch. f. klin. Chir.,

1890, xl, 838.


CYSTS IN THE ABDOMINAL WALL. 241

Zumwinkel says that in Roser's case the cyst lay behind the navel, just extraperitoneally, whereas his cyst lay in front of the closed navel.

In Zumwinkel's case the skin surrounding the umbilicus was greatly thickened, the squamous epithelium in places being fully ten times as thick as normal.

In a case seen by Fox and MacLeod, and cited on page 268, there was a definite Paget's disease, due undoubtedly to the irritating discharge from skin remnants of the omphalomesenteric duct. Fox and MacLeod's patient was a sailor, sixty-five years of age, who came under the care of Mr. W. Turner, surgeon to the Dreadnought Hospital at Greenwich. In the umbilical region was a rounded, eczematoid patch, two inches in diameter, which had been forming gradually for eleven years.

On microscopic examination the outlying portion of the umbilicus showed the typical picture of Paget's disease. The central portion showed a covering of cylindric epithelium, and contained glands resembling those of Lieberkuhn. In this case there evidently had been remains of the omphalomesenteric duct at the umbilicus, and the continued discharge had set up a proliferation of the squamous epithelium. This case is reported in detail in Chapter XVII.


LITERATURE CONSULTED ON CYSTS IN THE ABDOMINAL WALL DUE TO REMNANTS OF THE OMPHALOMESENTERIC DUCT.

Bondi, J.: Zur Kasuistik der Nabelcysten. Monatsschr. f. Geb. u. Gyn., 1905, xxi, 729. Colmers, F.: Die Enterokystome und ihre chirurgische Bedeutung. Arch. f. klin. Chir., 1906,

lxxix, 132. Fox and MacLeod: A Case of Paget's Disease of the Umbilicus. Brit. Jour. Dermatol, 1904, xvi,

41. Wyss, Hans v. : Zur Kenntniss der heterologen Flimmercysten. Virchows Arch., 1870, li, 143. Zumwinkel: Subcutane Dottergangscyste des Nabels. Langenbeck's Arch, f . klin. Chir., 1890,

xl, 838.



Umbilicus (1916): 1 Umbilical Region Embryology | 2 Umbilical Region Anatomy | 3 Umbilical New-born Infections | 4 Umbilical Hemorrhage | 5 Umbilicus Granuloma | 6 Omphalomesenteric Duct Remnants | 7 Umbilicus Abnormalities | 8 Meckel's Diverticulum | 9 Intestinal Cysts | 10 Patent Omphalomesenteric Duct 1 | 11 Patent Omphalomesenteric Duct 2 | 12 Bowel Prolapsus at Patent Omphalomesenteric Duct | 13 Abdominal Wall Cysts by Omphalomesenteric Duct Remnants | 14 Omphalomesenteric Vessels Persistence | 15 Umbilical Inflammatory Changes | 16 Subumbilical Space Abscess | 17 Umbilicus Paget's Disease | 18 Umbilicus Infections | 19 Umbilicus Abnormalities 2 | 20 Umbilicus Fecal Fistula | 21 Umbilicus Round Worms | 22 Umbilicus Foreign Substance Escape | 23 Umbilical Tumors | 24 Umbilicus Adenomyoma | 25 Umbilicus Carcinoma | 26 Umbilicus Sarcoma | 27 Umbilical Hernia | 28 The Urachus | 29 Congenital Patent Urachus | 30 Urachus Remnants | 31 Urachal Remnants Producing Tumors | 32 Large Urachal Cysts | 33 Anterior Abdominal Wall Abscesses | 34 Urachal Cavities | 35 Umbilicus Acquired Urinary Fistula | 36 Urachal Concretions and Urinary Calculi | 37 Urachus Malignant Changes | 38 Urachus Bleeding into the Bladder | 39 Patent Urachus Tuberculosis | Figures

Reference

Cullen TS. Embryology, anatomy, and diseases of the umbilicus together with diseases of the urachus. (1916) W. B. Saunders Company, Philadelphia And London.

Historic Disclaimer - information about historic embryology pages 
Mark Hill.jpg
Pages where the terms "Historic Textbook" and "Historic Embryology" appear on this site, and sections within pages where this disclaimer appears, indicate that the content and scientific understanding are specific to the time of publication. This means that while some scientific descriptions are still accurate, the terminology and interpretation of the developmental mechanisms reflect the understanding at the time of original publication and those of the preceding periods, these terms and interpretations may not reflect our current scientific understanding.     (More? Embryology History | Historic Embryology Papers)

Cite this page: Hill, M.A. (2019, September 16) Embryology Book - Umbilicus (1916) 13. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Book_-_Umbilicus_(1916)_13

What Links Here?
© Dr Mark Hill 2019, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G