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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
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Chapter XXI. The Escape of Round Worms from the Umbilicus

Historic sketch.

Symptoms.

Cause of the fistula.

Treatment.

Tapeworm escaping from the umbilicus.

Detailed report of cases in which round worms escaped from the umbilicus.

The passage of worms from the umbilicus is uncommon, but, as pointed out by Leuckart, it is mentioned in the Hippocratic writings, and in the literature from time to time illustrative cases have been described. One of the early ones was that of Marteau, in 1756. Then followed the articles of Hamilton '(1786), Ossiander (1795), Poussin (1817), Borggreve (1841), Hecking (1842), v. Siebold (1843), Nicolich (1846), Bottini (1855), Richter (1855), Bedel (1856), Diez (1858), Davaine (1860), Weiss (1868), Kern (1874), Leuckart (1876), Nicaise (1881), Ledderhose (1890), and others. Since 1890 very little has been written on the subject. This is but natural, as with the perfecting of surgical methods abdominal lesions have, as a rule, been treated in the early stages, thus to a large extent limiting the incidence of fecal fistulae, which were usually necessary for the escape of worms. Nevertheless, it must be mentioned that in a few cases the escape of worms from the umbilicus has not been preceded by or followed by that of fecal matter. The best articles that we possess on the subject are those of Davaine, Weiss, and Nicaise. Weiss, in his inaugural dissertation, published in Giessen in 1868, reports several very interesting cases and then gives a short historic sketch.

Weiss cites cases observed by various authors. In Capallaria's case, worms escaped from the umbilicus. In a case observed by Petrus Forestus the patient was a woman, forty years of age, who had a tumor at the umbilicus. The tumor broke and feces and several worms escaped. The later history of this patient is not given.

Frincavello's patient, a boy five years old, passed worms from the umbilicus. Cladus reported the case of a patient who passed plum-stones and worms from the umbilicus.

Creulin's patient was a girl who had an umbilical tumor, which ruptured and three worms escaped from it. Healing followed.

Boire's patient was a young girl from whose umbilicus seven worms escaped.

Weiss next reports the observations of Hamilton and Dregogirone, made on small children. In these cases worms escaped from the umbilicus. Weiss says that similar observations had been made by Pouspin* and by Cappola. He then refers to a report by Beilman,f under whose observation was a child that vomited worms. They also escaped by the rectum and from an abscess at the umbilicus. Weiss further mentions that similar cases had come under the observation of Paul of iEgina, Alix Trailer, Avicenna, Feli-Plater, and Bianchi.

  • Pouspin: Jour, de Corvisart, 1817, xi. f Beilman: Bull. d. sc. med., 1831, xxv.

328


THE ESCAPE OF ROUND WORMS FROM THE UMBILICUS. 329

Finally he reports the observation of Ambroise Pare. The patient was a woman who had an ulcer at the umbilicus, from which a number of worms escaped. The fistula remained open for a long time, and a fecal discharge persisted. Finally it closed and healing took place.

SYMPTOMS.

The majority of these patients have symptoms of a gastro-intestinal disturbance, and after a period varying from a few days to a couple of weeks develop a soreness at the umbilicus. The center of the umbilicus gradually becomes softened, and the surrounding portions are thickened and edematous. In Sanchez' case the swelling became as large as a child's head.

In the course of a few days, usually as result of the use of poultices, the abscess breaks and there is an escape of pus. Sometimes this is accompanied by fecal matter or round worms or both; occasionally fecal matter is not detected at all, the wound closing up after the pus and worms have escaped. The worms may be alive or dead. Occasionally only one worm escapes, but, as a rule, several come away at once. Closure of the wound may occur temporarily, only to be followed by more pain and the expulsion of more worms.

In two cases, those of Beilman and Heer, cited by Weiss, the patients not only passed round worms by the umbilicus and the bowel, but also vomited them.

The majority of the patients recover, but the outcome depends in a large measure on the cause of the fistula.

CAUSE OF THE FISTULA.

Davaine, in his excellent work published in 1860, gives a table of 47 cases in which worms passed through the abdominal wall. According to these figures, the point of exit was: the umbilicus in 19 cases; the groin in 21 cases; other regions in 7 cases — thus demonstrating that it is at the points, where hernia? are most prone to occur, that worms escape.

He also draws attention to the fact that in children the worms usually escape from the umbilicus, whereas in adults the inguinal region is the most common site of exit. His table gives the following:

From the umbilicus in patients less than fifteen years of age 15 cases

From the umbilicus in patients more than fifteen years of age 4 cases

From the inguinal region in patients less than fifteen years of age 2 cases

From the inguinal region in patients more than fifteen years of age ... 19 cases

The reason for this difference is obvious: in the child the umbilicus represents the weakest point in the abdominal wall, but as the child develops into adult life the umbilicus usually becomes firmly knit and the inguinal region is the area most prone to give way.

Where tuberculosis of the intestine exists, it is readily seen that an ulcerated area may become adherent to the umbilicus and that, with masses of round worms lying in the intestine, these might readily injure the friable walls, causing an abscess and the escape of fecal matter from the umbilicus. Again, where typhoid fever has recently been present, as in Diez's case, the ulceration may have extended deep into the intestinal wall, thus rendering the outer or peritoneal surface of the intestine liable to become adherent to the surrounding structures. If it becomes adherent to the umbilicus, abscess formation might readily occur. We have, however,


330 THE UMBILICUS AND ITS DISEASES.

only one example of such an occurrence. In the majority of the cases the patient first had gastro-enteric symptoms, which were followed by localized tenderness at the umbilicus.

In the older literature a spirited controversy arose as to whether the lumbricoid worm could penetrate the normal intestinal wall, some claiming that it could, others that it was not capable of doing so. Davaine, from his observations, concluded that lumbricoids do not perforate the healthy intestine, but he would not deny that a soft, ulcerated intestine might yield and perforate as a result of pressure exerted by the head of the Ascaris lumbricoides.

If a large fecal concretion is capable of causing ulceration and perforation of the intestine, it does not seem difficult to understand how masses of round worms might cause ulceration of the intestine with subsequent perforation.

In the cases reported by Hamilton, Poussin, and MacSwiney, the previous histories were strongly suggestive of the existence of a patent omphalomesenteric duct. In such cases it was only natural that the worms should escape along the preexisting fistulous tract to the umbilicus. In some cases the patent omphalomesenteric duct was so small that no fecal matter escaped until a worm was seen projecting through the umbilicus or was noted crawling on the abdomen.

TREATMENT.

This will, of course, depend on the cause of the fistula. As will be seen from a study of the appended histories, worms were expelled from time to time. Accordingly, it will be advisable, after the patient has gained in strength, to give an anthelmintic. "When the bowel shows no further trace of worms, and when the umbilical induration has disappeared, nothing but a fistulous tract remaining, the abdomen should be opened and the hole in the bowel closed. If a patent omphalomesenteric duct has been the cause of the fistula, it can readily be removed, the same technic being employed as for an appendix operation. If the previous history suggests an appendix abscess with escape of feces, abscess formation, and the escape of its contents through the umbilicus, the appendix region should also be explored, provided the dangers of a general peritoneal contamination are not too great.

In some of those cases, in which the worms seemed to escape from an intestinal loop which had become directly adherent to the umbilicus, the wound closed spontaneously after all the worms had been expelled. Where a fistula still persists, it can be readily closed by operation. In case the perforation has been followed by an abdominal abscess and this has later opened at the umbilicus, the bowel opening at the bottom of an abscess may be lined with granulation tissue. In such a case closure of the hole in the bowel is not only a difficult procedure, but, on account of the necessary drainage, is apt to be followed by failure or by a general peritonitis.

In those cases in which the fecal fistula is of tuberculous origin, one should hesitate long before attempting to close it, as on account of the friable character of the tissues the end-result may be worse than that present at the time of operation.

TAPEWORMS ESCAPING FROM THE UMBILICUS. From the foregoing we have seen that round worms may occasionally escape from the umbilicus. If a fecal fistula exists in this situation and the intestine contains a tapeworm, there is no reason why it should not escape in a similar manner.


THE ESCAPE OF ROUND WORMS FROM THE UMBILICUS. 331

Siebold, in 1843, reported such a case. In April, 1841, Siebold saw at the clinic in Erlangen a man, aged twenty-two, who had had scrofula in childhood and who had had numerous abscesses. At the umbilicus was an elevation. One day, after the patient had been given a certain decoction, a physician was called because there was something alive at the umbilicus. Six inches of a taenia solium were protruding from the umbilical opening. Traction was exerted, and the head came away. Several meters of the lower portion were drawn out; in other words, the entire worm was extracted with ease. No fecal matter or gas escaped. The man did not improve, but died of pulmonary tuberculosis.

Richter, in 1855, reported a case in which a tapeworm escaped from the anterior abdominal wall. A man, thirty years of age, had had an abdominal inflammation of unknown origin. Poultices were applied for months, and an abscess developed in the abdominal wall to the right of the mid-line. A fistulous tract passed upward toward the liver. The fistula discharged pus. Feces were never observed. From time to time living portions of tapeworms, however, escaped.

Tillmanns, in his article on Congenital Prolapsus of the Stomach Mucosa through the Umbilicus, says that v. Siebold had spoken of two cases in which tapeworms had escaped through the abdominal wall. One case was reported by Monleng, and the condition was associated with a definite fecal fistula. The second was reported by Sporing. [We have the record of only one case, namely, that of Siebold, in which a tapeworm escaped from the umbilicus itself.]

DETAILED REPORT OF CASES IN WHICH ROUNDWORMS ESCAPED FROM THE

UMBILICUS.*

Escape of Round Worms From the Umbilicus.f — Bedel mentions two cases related to him by his uncle, Dr. Bedel. The patients were two brothers, one eleven, the other thirteen. Each passed round worms from the umbilicus within one month.

Escape of Round Worms From the Umbilicus. t — The patient was a boy, four years old. The umbilicus had been transformed into a "pus-bladder," and around it was a reddening. When the child was put to bed for examination, he turned suddenly and the abscess broke. A worm was found projecting from the umbilicus. The next day the family showed the doctor three more worms. With the use of bandages and applications of carbolic acid the wound healed. Berner thought there must have been a diverticulum in this case.

Escape of a Worm Through the Umbilicus. — ■ Weiss § reports a case observed by Blanchet.|| An adult male had severe pain in the umbilical region. The umbilicus commenced to increase in size, and eight days later fluctuation was detected. At the most prominent part of the tumor a painful dark point developed. The abscess was opened, and much fluid and one worm escaped. Fourteen days later the wound had healed completely.

  • I wish to express my thanks to Dr. Charles W. Stiles, of Washington, for his kindness in

supplying me with the more recent references on this subject.

t Bedel: Bull, de therapeutique, 1856, li, 550.

J Berner, H. : Entleerung von Spulwiirmern aus dem Nabel. Aerztliches Intelligenzbl., Miinchen, 1876, xxiii, 238.

§ Blanchet (Cited by E. Weiss) : Ueber diverticular Nabelhernien und die aus ihnen hervorgehenden Nabelfisteln. Inaug. Diss., Giessen, 1868.

|| Blanchet: Acad, med., Paris, 1827.


332 THE UMBILICUS AND ITS DISEASES.

Escape of Round Worms Through the Umbilicus. — ■ In 1833 Borggreve* saw a five-year-old boy who, for fourteen days, had had pain in the umbilical region associated with general symptoms suggesting worms. Examination later showed an opening at the umbilicus, and projecting from this was the snout of a round worm. The worm was carefully grasped with forceps and drawn out. It was eight inches in length. An appropriate vermifuge was given, and 21 large worms passed from the umbilicus and five from the rectum. The umbilical opening later closed spontaneously.

Escape of Round Worms Through the Umbilicus, f- — A ten-year-old boy, who had always been healthy, developed severe gastro-enteritis. On the fourth day the umbilical region was raised and surrounded by a red zone. Warm applications were made. The umbilicus opened, and three round worms escaped. Two more came away from the umbilicus the same evening. On the fifth day the general symptoms disappeared and feces escaped from the opening. A compression bandage and frequent cauterization brought about healing in one month.

Escape of Round Worms From the Umbilicus. — ■ CasaliJ reports a case in which round worms escaped from the umbilicus.

Escape of Worms From the Umbilicus. § — A woman, sixty years of age, had had symptoms of enteritis. An abscess developed at the umbilicus and 36 worms escaped. Weiss, when speaking of this case, compares the observation to those of Borggreve, Glos, Bottini, Diez, and Finger.

Round Worms at the Umbilicus. || — A nine-year-old girl, in April, 1855, had a severe attack of typhoid fever, and during convalescence a small tumor developed at the umbilicus. Its formation was accompanied by much pain, and the skin was red. Poultices were applied, and pus having the odor of feces escaped. There was no doubt that the abscess communicated with the bowel. Daily applications of caustics caused the opening to close in fourteen days. Nine months later the child had sudden pain and the umbilicus opened in a few hours. A live round worm appeared. This was pulled out, its removal occasioning much pain. In the course of the next fourteen days nine more worms came away. The opening then closed without treatment.

In 1857 the umbilicus, which in the mean time had been closed, again opened, and in three days nine live round worms escaped. After the giving of appropriate medicine six more worms were passed, this time by the rectum. The fistula closed and gave no further trouble.

Escape of Worms From the Umbilicus. — Weiss** gives a description of a case reported by Girone. ft A fourteen-year-old boy had suffered for some time with tabes mesenterica and was confined to bed. His abdomen was swollen and he had fever. For one year he complained of pain in the side. The

  • Borggreve: Abgang von Spulwiirmern durch den Nabel. Medicinische Zeitung. 1841,

x, 117.

t Bottini, G. D.: Schmidt's Jahrbuch, 1855, lxxxv, 308.

% Casali, T.: Un caso di elmintiasi con fuorinscita di ascaridi lombricoidi dah" ombellico. II Raccoglitore medico, 1879, serie iv, xii, 281.

§ Denaire (Cited by E. Weiss) : Op. cit., obs. 4.

J| Diez: Spulwiirmer im Nabel. Med. Correspondenz-Bl. des Wurtemberg. aerztlichen Vereins, Stuttgart, 1858, xxviii, 95.

    • Girone: Cited by E. Weiss, op. cit., 1868. ft Girone: Gaz. med. de Paris, 1838, p. 231.


THE ESCAPE OF ROUND WORMS FROM THE UMBILICUS. 333

urine was cloudy and the stools liquid. The pains gradually increased, and finally an abscess appeared at the umbilicus, which opened spontaneously, and four round worms escaped. Fecal matter also came from the fistulous tract. The opening closed completely.

A Case of Worms Escaping Through an Opening at the Navel. — According to Simmons, Hamilton* made the following report in a letter : A male child, a year and a half old, was thought by the mother for several weeks to have had worms. The umbilicus protruded about an inch and appeared inflamed. The mother said that the person who had cared for the child for a few days after its birth drew the bandage from the umbilicus too suddenly, and with the bandage the remains of the cord, before it had been completely separated. She added that, though the part healed, it had always remained tender. To prevent its protruding too much, a bandage had been applied pretty tightly over it. Soon after that the child seemed to have symptoms of worms, and on untying the bandage the mother observed a worm about seven inches long crawling over the abdomen. In the middle of the umbilicus were two small holes, out of one of which the worm had just issued. Before long two more came away through the same opening. One of the worms had protruded itself two inches when she pulled it away with the fingers. The next day two more worms came away. All of these were six to eight inches long and alive when they escaped. At the end of ten days six more came away in the course of twenty-four hours. In the succeeding five weeks no more had escaped and the opening had closed. The umbilicus was the size of a walnut, and evidently diseased, but the child continued well.

Escape of Round Worms Through a Fecal Fistula at the Umbilicus. f — Weiss mentions a case recorded by Heer.i A young girl vomited worms and also passed them by the bowel. An abscess developed at the umbilicus. This was opened, and a round worm escaped. Healing soon took place. Escape of Round Worms From the Umbilicus. § — A four-year-old girl for eight days had been complaining of an inflammatory swelling at the umbilicus. After the application of poultices the swelling opened and there escaped a foul-smelling pus, together with three dead round worms. In a few days the umbilical opening closed and the child recovered. Two months later she was again ill with symptoms of worms. The umbilicus again became prominent and inflamed, opened, and discharged several more worms. The wound closed, and thereafter there were no further signs of worms.

Escape of Worms From the Umbilicus. || — The patient was a seven-year-old boy who complained of pain in the lower abdomen. An umbilical abscess developed, and from it there escaped 41 round worms. The opening closed. Four months later it opened again and 11 worms escaped. The colic disappeared; nevertheless, no closure took place and a fecal fistula developed.

Extraction of Ascaris Lumbricoides From the Umbilicus.** — A boy, four years of age, had been in good health until five months

  • Hamilton, Robert: London Med. Jour., 1786, vii, 372.

t Heer: Cited by E. Weiss, op. cit. % Heer: Revue med., 1837.

§ Hecking: Entleerung von Spulwurmern durch den Xabel. Generalber. des Konigl. Rheinischen med. Coll. fur 1839, Coblenz, 1842, 80. || Lini: Cited by E. Weiss, op. cit., p. 13.

    • Macphail, Donald: Glasgow Med. Jour., 1884, xxii, 382.


334 THE UMBILICUS AND ITS DISEASES.

before admission. Shortly before coming under observation he had been treated for thread-worms. Five months before admission he had become restless, listless, cross, and had had diarrhea. The abdomen was swollen and tender and emaciation was noted. The condition gradually grew worse. The abdomen became prominent and tense, and the superficial veins were much enlarged. He was very weak, emaciated, and apathetic. The diarrhea was severe, and there was sweating every night. At this time a thin, watery pus commenced to escape from the umbilicus. This was very offensive, but had no fecal odor. During the next three weeks the condition was still worse; the discharge from the umbilicus became more abundant and excoriating. Later there was difficulty in micturition, with retraction of the testicles. Between the umbilicus and the pubes was a diffuse, slightly elevated swelling, which was very tender, but there was no redness. A few days later the child was almost moribund, and there was edema of the feet and legs. Protruding from the umbilicus were two inches of a wriggling round worm which was easily drawn out. It was nine inches long. There was rapid improvement in the child, but he was still very thin. When the case was reported before the medical society, the possibility of an open omphalomesenteric duct was considered.

The Passage of Chyle and Worms From the Umbilicus.*' — The patient was a girl seven years old. She had a well-marked ascites. There was a historj^ of ascites on previous occasions. When two years of age she had ascites, which disappeared in three months. A few months before Marteau saw her ascites again developed. On admission there was a hard and inflamed tumor at the umbilicus. After the application of poultices the swelling became circumscribed and opened. Escaping with the pus were three lumbricoid worms. Following these, chylous material escaped. The opening persisted for six months and discharged pus, chyle, and pieces of undigested food, and from time to time round worms escaped. After six months the tract cicatrized, and thereafter there was nothing but a thin serous discharge. The child was well nourished. The exact cause of the trouble was impossible to determine.

Ascaris Lumbricoides Extracted From an Umbilical Fistula, t — A boy, seven years old, came to the hospital with an ascaris lumbricoides projecting two and one-half inches from the umbilicus. "I at once proceeded to deliver it in an artistic way, and I had to exercise some caution in the operation lest it should break, as there was considerable tension on the creature, and it was evident that its body was tightly compressed in a track or sinus, through which it was slowly making its way out." The father of the boy stated that since birth there had been a fistula at the umbilicus, and that it had constantly discharged. There were never, however, any signs of blood, bile, or feces. The discharge was clear yellow matter with no feculent odor. MacSwiney says his friend, Dr. Kelly, thought the fistula was due to an unclosed vitelline duct.

Escape of Round Worms From the Umbilicus. J — A woi i j an, twenty-five years of age, who had had two normal labors, complained of severe pain in the hypogastric region shortly after the second labor. The menses ceased, and the physician thought a new pregnancy was under way. Finally the

  • Marteau: Sur une ouverture a 1'ombilic qui donnoit passage au chyle et a des vers contenus dans les intestins greles. Jour, demed., Paris, 1756, v, 100.

+ MacSwiney, S. M.: Proc. Path. Soc. of Dublin, 1873-75, vi, 251.

% Nicolich: Abgang von Spulwurmern aus dem Nabel. Schmidt's Jahrbuch, 1846, 1, 53 (translated from Gaz. di Milano, Xo. 11, 1845).


THE ESCAPE OF ROUND WORMS FROM THE UMBILICUS. 335

abdominal wall from the umbilicus to the symphysis became bright red. Applications were made, and the umbilicus opened. There was an escape of a moderate amount of foul-smelling pus, but no fecal masses. Several days later three round worms escaped, and a few days after this six more worms passed from the umbilicus. The pain became pronounced in the inguinal regions, and pressure here caused a moderate amount of pus to escape from the umbilicus.

Fecal Fistula at the Umbilicus.* — The patient was a delicate boy who had previously passed lumbricoid worms. Toward the end of 1795 he complained of abdominal pain. There was distention and an area of inflammation at the umbilicus which seemed ready to rupture. The tumor, however, gradually receded. In March, 1796, the patient developed a severe cough. Before Easter the abdomen again became distended, and the umbilicus was very prominent, red, and painful. The skin was glistening and distended, and there was a marked degree of emaciation. On March 31st there was a rupture, with the escape of pale yellow, fetid fecal masses. The boy died on April 4, 1796. At autopsy the abdomen was found distended. The opening at the umbilicus was sealed up with dry pus. The peritoneum contained many small and large nodules, and from several openings beneath the stomach region four live round worms came away. The larger opening admitted the index-finger and was on the right, beneath the liver. Attached to the umbilicus was an intestinal loop, and from this pus had escaped. The mesenteric glands were enlarged and hardened.

Escape of Several Round Worms From the Umbilicus . f — The patient was a boy, three years of age, and of healthy parentage. The nurse made traction on the cord on the fifth day, as it had not come away. "Inflammation" followed, and a small opening developed. Sometimes this would close for three weeks or a month, but never for a longer period. On examination the mother was surprised to see a worm half an inch long crawling along the abdomen. The child, who had been sick, rapidly recovered. Several weeks later two worms similar in character were extracted from the umbilical fistula. In the intervals between the times of abdominal pain the child enjoyed good health, except for an occasional discomfort due to worms. At the umbilicus was a slight projection the size of a chestnut with an opening in the center. Escaping from this were contents resembling feces. On several occasions the physician was called to see the child when in great pain, and removed lumbricoid worms from the fistula. Some of these worms reached four and one-half inches in length.

[The history is strongly indicative of a patent omphalomesenteric duct.]

Round Worms Escaping From the Abdomen. — Richter| speaks of cases reported by Baumann, and one by Winterich, in which round worms were passed at the umbilicus, and says that such an occurrence is not rare.

Escape of Round Worms From a Fecal Fistula at the Umbilicus. § — This case came under the observation of Sanchez. || The patient was a woman who developed a tumor at the umbilicus. After two years

  • Ossiander: Neue Denkwlirdigkeiten ftir Aerzte und Geburtshelfer, i, 2. Abtheilung.

Cited by Schrotter.

t Poussin : Observation sur 1' expulsion de l'abdomen par une ouverture a l'ombilic de plusieurs vers ascarides-lombricoides. Jour, de rued., 1817, xl, 81.

t Richter: Bandwurmglieder aus einer Bauchfistel entleert. Schmidt's Jahrbuch, 1855, lxxxv, 308.

§ Sanchez: Cited by E. Weiss, op. cit., obs. 3.

|| Sanchez: Gaz. Med. Italiana, 1862, v. 284.


336 THE UMBILICUS AND ITS DISEASES.

this formed an abscess and a fecal fistula developed, from which three worms escaped. When St. Sardi saw the patient, the tumor at the umbilicus was the size of a child's head. Pus flowed from it without any diminution in size of the tumor. With a probe an intestinal stone could be felt. This was removed at operation. The nucleus of the stone consisted of hardened feces and was covered over with earthy phosphates. The patient died fourteen days after operation.

A Round Worm at the Umbilicus. — Weiss* says that in the Journal de Progres, 1834, the case of a sixteen-year-old negro was recorded. The patient had a phlegmonous tumor at the umbilicus, and gave a history of having passed 92 worms at stool. The tumor was opened, and in it was found a halfdigested worm.

  • Weiss, E.: Op. cit.

LITERATURE CONSULTED ON THE ESCAPE OF WORMS FROM THE UMBILICUS.

Bedel: Bull, de therapeutique, 1856, li, 550.

Berner, H.: Entleerung von Spulwurmern aus dem Nabel. Aerztliches Intelligenzbl., Munchen,

1876, xxiii, 238. Borggreve: Abgang von Spulwtirmern durch den Nabel. Med. Zeitung, 1841, x, 117. Bottini, G. D. : Schmidt's Jahrbuch, 1855, lxxxv, 308. Casali, T.: Un caso di elmintiasi con fuorinscita di ascaridi lombricoidi dall' ombellico. HRac coglitore medico, 1879, ser. iv, xii, 281. Davaine, C. : Traite des entozoaires, Paris, 1860, 115. Diez: Spulwiirmer im Nabel. Med. Correspondenzbl. des Wurtemberg. aerztlichen Vereins,

Stuttgart, 1858, xxviii, 95. Hamilton: Case of Worms Discharged through an Opening in the Navel. London Med. Jour.,

1786, vii, 372. Hecking: Entleerung von Spulwurmern durch den Nabel. Generalbericht des Konigl. Rhei nischen med. Coll. f. 1839, Coblenz, 1842, 80. Kern, Theo.: Ueber die Divertikel des Darmkanals. Inaug. Diss., Tubingen, 1874. Ledderhose, G.: Chirurgische Erkrankungen des Nabels. Deutsche Chirurgie, 1890, Lief. 45 b. Leuckart, R.: Die menschlichen Parasiten und die von ihnen hervorgehenden Krankheiten.

Leipzig, 1876, ii, 241. Macphail, Donald: Ascaris Lumbricoides Extracted from the Umbilicus. Glasgow Med. Jour.,

1884, xxii, 382. MacSwiney, S. M.: Proc. Path. Soc. of Dublin, 1873-75, vi, 251. Marteau: Sur une ouverture a l'ombilic, qui donnoit passage au chyle et a des vers contenus

dans les intestins greles. Jour, de med., Paris, 1756, v, 100. Nicaise: Ombilic. Dictionnaire encyclopedique des sc. med., Paris, 1881, 2 ser., xv, 140. Nicolich : Abgang von Spulwurmern aus dem Nabel. Schmidt's Jahrbuch, 1846, 1, 53. (Translated from Gaz. di Milano, No. 11, 1845.) Ossiander, F. B.: Original not located. Neue Denkwiirdigkeiten fur Aerzte und Geburtshelfer,

i, 2. Abtheilung. Reported by Schrotter. — Schrotter, E.: Zur Kenntnis der Tuberculose

der Nabelgegend. Arch. f. Kinderheilkunde, 1902-1903, xxxv, S. 413. Poussin: Observation sur l'expulsion de l'abdomen par une ouverture a l'ombilic de plusieurs

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Inaug. Diss., Giessen, 1868.



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.

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