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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 XXXVI. Urachal Concretions and Urinary Calculi associated with Urachal Remains

Historic sketch.

Urachal stones or concretions.

Urinary calculi in the urachus.

Removal of vesical stones through the umbilical opening.

Other calculi in the umbilical region.

Phillips, in an article in Todd's Cyclopaedia of Anatomy and Physiology (1835), said that in January, 1787, Boyer exhibited a bladder taken from a man thirty-six years of age. The urachus formed a canal 1^2 inches long, and contained 12 urinary calculi each the size of a millet-seed. It was demonstrated that this canal was not a vesical sac or a prolongation of the vesical mucous membrane.

In 1838 Civiale, in his treatise on calculous affections, called attention to the fact that the anatomist Colombus had observed calculi at the umbilicus. Civiale refers to the case of a woman coming under Hagendorn's care, who had a very painful abdominal abscess which contained two calculi. He also refers to Vallisnieri, who spoke of stones escaping from the umbilicus. In Helwig's case, cited by the same author, a woman seventy years old had an umbilical abscess; it broke, and several stones escaped, one of which weighed 15 grains. In another case a man discharged from the umbilicus a calculus which weighed about an ounce and was as large as a pigeon's egg. Civiale also referred to cases observed by Tolet, Rhodius, and Roesler. The stones varied from the size of the kernel of an olive to that of a hazelnut. They escaped from the umbilicus.

Simon, in 1843, mentioned the fact that calcareous concretions had been found along the course of the urachus and had also escaped through the umbilical ring. He said that Colombus, Donatus, Harder, Bartholin, and Cruveilhier had reported such cases. '

Simon said that Rhodius and Helwig had reported cases similar in character. In the case of Helwig's patient, a man, the stone was the size of a pigeon's egg.

Concretions or calculi escaping from the umbilicus may originate from several sources. They may be formed in the bladder or in the urachus, which communicates with the bladder, and where, consequently, urinary salts can become concentrated, or, again, in a urachus, that is completely isolated from the bladder. Finally we have umbilical concretions. The escape of gall-stones from the umbilicus has been considered elsewhere.

Calculi developing in a urachus communicating with the bladder are identical in their composition with vesical stones. Those developing in the urachus, when no connection exists between it and the bladder, are very small; umbilical concretions are cheesy in character. These last have been considered in detail in Chapter XV (p. 247).

The majority of the cases mentioned in the historic sketch just given are not sufficiently clear to enable one to determine with any degree of accuracy to which group they belong.

Urachal Stones or Concretions

The careful and painstaking investigations of Luschka, published in 1862, give us a very comprehensive knowledge of the urachus. He says the urachal contents are not all alike. The fluid is usually pale yellow, thin, and translucent. It may, however, be cloudy, and brown or reddish in color. It contains a large number of cells, numerous fat-globules, and not infrequently corpora amylacea. In the dilatations and in the isolated cysts the contents are frequently sticky and of a dirty brown color, and scattered throughout the field are bodies which have a marked resemblance to prostatic concretions.

Urachal concretions were also described by Hoffmann in 1870.

Suchannek, in 1879, when describing the contents of a patent portion of the urachus, discussed the granular bodies. These, he said, judging from their reaction to acetic acid, are due to a degeneration of the epithelium, which is probably colloid or amyloid in character.

Wutz briefly details his findings in the cyst contents of the many cases he examined.

In Case 11 he noted that, a short distance from the bladder, the urachus contained an oval body 0.17 x 0.1 mm. It was brownish in color and homogeneous in consistence. In the further course of the tube were several diverticula and nippedoff cysts of various shapes. They contained firm brownish contents.

In Case 15 Wutz says that the cysts were filled with lumps of brownish and yellow material.

In Case 17 the cyst contents were yellowish white and friable.

In Case 18 Wutz found a spindle-shaped urachal cyst, 2x1 mm. Its contents were brownish yellow in color.

Wutz, in summing up his observations on cyst-contents, said that they consisted of fat-crystals, fat-droplets, free fat, large flat epithelial cells, brownish-yellow amorphous masses, isolated cholesterin crystals, and small, round, very glistening bodies. In one of the cysts in Case 22 he found a small, firm, stony hard, yellowish-brown, glistening body. Under the microscope this was irregular, nodular,\ and partly transparent. It was 0.37 x 0.36 mm. in diameter. On the addition of hydrochloric acid free carbonic acid escaped.

Ledderhose referred briefly to urachal concretions in 1890.

In Boyer's case, which we have already considered and In which 12 millet-seedsized stones were found in the urachus, these bodies were urinary stones.

Rokitansky (1861) referred to a case in which 21 calculi the size of linseeds were found in a urachal dilatation 0.6 mm. above the top of the bladder.

Veiel, one of Luschka's pupils, in his dissertation on the urachus published in 1862, described his findings in the body of a man forty-five years old. "Passing downward in the mid-line from the umbilicus was a delicate cord 1 mm. broad. Three centimeters above the bladder it commenced to get thicker, and at the bladder was 1.2 cm. broad. The urachus could be divided into four sections. The lowest section, situated nearest the bladder, was 14 mm. long and patent. The next was 7 mm. long, solid, and thread-like. The third was 8 mm. long and was also patent. The fourth section— nearest the umbilicus— was solid. After the urachus had been


622 THE UMBILICUS AND ITS DISEASES.

treated with acetic acid, three dilatations of the canal could be seen. They contained yellowish concretions.

Arrou, in 1910, in an article entitled A Suppurating Cyst of the Urachus, reported a case in which an abscess contained a stone or concretion the size of an olive; it was like a piece of incompletely dried mortar. [I should be inclined to look upon it as a simple umbilical concretion accompanied by inflammation, were it not for the fact that the lower end of the sac bore a definite relation to the urachus. — T. S. C]

Suppurating Cyst of the Urachus. — Arrou* reports the case of a patient operated upon by Tricot. A soldier with absolutely no history of bladder trouble complained of vague pain in the umbilical region. The pain became acute, and the patient when marching had to bend forward. There was no nausea and no intestinal disturbance. Urination was normal; there was no fever.

Examination revealed a painful plaque, as large as the palm of the hand, a little below the umbilicus. There was no edema or redness. Gradually a little swelling was noted over the painful area; this was accompanied by some fever.

Operation. — An exploratory incision was made under the supposition that there was an abscess in the abdominal wall, but when the patient was in the operatingroom, there was an escape of a small amount of pus from the lower margin of the umbilicus. A probe introduced into the small orifice passed downward and backward into a cavity, measuring 6 cm. in its vertical direction. The patient was at once anesthetized and the cavity incised. It proved to be the size of a mandarin orange. It contained a calculus the size of an olive, that was like a piece of incompletely dried mortar. The cyst lining resembled an inflamed mucosa. Unfortunately, both sac and calculus were lost.

The upper end of the sac ended at the bottom of the umbilicus. The lower extremity terminated in a closed cul-de-sac. Attached to the lower portion of the sac was a large cord, the size of the little finger, which became smaller and terminated in the fundus of the bladder. Arrou was sure that it was the urachus. The peritoneum was opened above and laterally. The intestines were protected and the urachus was cut across with the cautery at a point several millimeters above the bladder. The sac was completely removed and the wound closed. The patient made a good recovery.

From the data at hand it is evident that urachal concretions or stones are very rare. They are usually no larger than linseed grains or millet-seeds. They are usually yellowish brown or brown in color, and may resemble corpora amylacea. They are too small to be a surgical factor, and are of interest only to the pathologist.


URINARY CALCULI IN THE URACHUS. In 1877 Vosburgh reported his observations on a man aged fifty, who had been complaining of a soreness and constant pain at the navel. Examination showed redness, tenderness, and a hard swelling around the umbilicus. The tumor was incised, and at the depth of half an inch a stone, the size of a hickory-nut, was felt and at once removed. The stone was phosphatic in character and had a strong urinary odor. The wound healed. The patient stated that, about twenty years before, a stone had been removed in a similar manner from this location.

  • Arrou: Kyste suppure de l'ouraque. Bull, et Mem. de la Soc. de chir., Paris, 1910, xxxvi, 832.


CALCULI ASSOCIATED WITH URACHAL REMAINS. 623

Monod, in 1899, referred to the stagnation of urine in the interior of the urachus as giving rise to calculi. He said that Colombus, Marcellus, Donatus, Harder, and Bartholin had cited examples of this kind. He added that the calculi may be eliminated through the umbilicus, as was noted by Hagendorn, Rhodius, and Hehvig.

The same author mentions a case recorded by Peyer in 1721, in which a calculus escaped from the umbilicus after retention of urine. In the chapter on Urachal Infections I have referred to a case reported by Weiser (p. 603). The patient, a woman seventy-five years of age, had had a purulent discharge from the umbilicus for fifteen years. When Weiser saw her she had a tumor the size of a cocoanut situated in the mid-line, between the umbilicus and symphysis. When this was opened, five ounces of very fetid pus escaped, and also a calculus weighing 70 grains. The wound healed in three months. Wishing to find out the character of this stone, I wrote Dr. Weiser, and from his reply it appears probable that it closely resembled a vesical calculus, but, as noted from the history, there was no opening into the bladder and no urine escaped from the incision during the patient's convalescence.

Probably one of the most interesting cases is the one recorded by Dykes. It might be claimed that the extravesical portion of the stone developed in a diverticulum of the bladder, but the location of the opening in the top of the bladder and in the median line leaves little doubt that the cavity was a dilated portion of the urachus, especially as the probe in the cavity could be carried up to within two inches of the umbilicus.

Patent Urachus and Encysted Urinary Calculi.* — "This case, which both in its clinical and pathologic bearings I believe to be of some interest, came under observation on January 27, 1908, at Rae Bareli Oudh:

"The patient was a Hindu male, aged about thirty years, apparently healthy apart from his urinary complaint, which dated back some five years or more. Owing to pressure of work I had not seen him until he was on the operating table, prepared for litholapaxy. The urine, I was informed, was acid and free from albumin. Several small concretions lay free on the base of the bladder, but on commencing to crush the first, the beak of the lithotrite impinged upon what appeared to be a much larger calculus, occupying a position at the apex of the half -distended bladder. After the first stone had been crushed the projecting portion of this larger calculus was easily seized between the blades of the lithotrite, but was found to be fixed to the bladder- wall.

"To crush this calculus in situ appeared dangerous, if not impossible, so lateral lithotomy was performed and the forefinger passed into the bladder. The calculus was now found j ust within reach of the finger. With the forefinger on the tip of the calculus and the other hand on the abdominal wall, it was estimated to be of considerable size, and its upper portion seemed very close under the examining hand beneath the abdominal wall in the middle line. It was evidently an 'hour-glass' stone, the deeper half being considerably larger than the projecting portion felt by the finger. The projecting portion being steadied in the grasp of the lithotomy forceps, the perforated end of a long probe was insinuated alongside the neck, and gradually manceuvered around the whole circumference, loosening the retaining tissue, until, by gentle traction and rotation of the forceps, an 'hour-glass' calculus was safely delivered. A second calculus immediately dropped from the same pocket into the bladder cavity. It, together with the three small concretions, the presence

  • Dykes, Campbell: The Lancet, 1910, i, 566.


624 THE UMBILICUS AND ITS DISEASES.

of which, on the bladder floor, had already been detected, was now removed, and the debris of the small stone, first crushed, washed out. In case other concretions might still be lying in the pocket its recesses were explored with a probe. Nothing further was found, but the probe passed up in the middle line, easily palpable through the abdominal wall, to a point two inches below the umbilicus. At the upper end the pocket seemed to be contracted to a mere sinus. Convalescence was rapid and uncomplicated.

"The ' hour-glass ' calculus weighed over l^ ounces. Its neck was of about the thickness of a cedar pencil, but somewhat flattened. The deeper lobe was larger than the projecting head, which was capped by a pea-sized, rough, dark-colored concretion, easily broken off, when drj", from the head proper. This terminal concretion resembled exactly, in color and approximately in size, the four small concretions which had been found free in the bladder, differing only in being rough and not polished or faceted by attrition. This resemblance strongly suggested that these four also owned the same source, from the head of the ' hour-glass ' calculus. Each weighed about 10 or 12 grains. The second encysted calculus showed a large oval facet corresponding to a like facet on the base of the 'hour-glass' calculus. Its longer axis had lain at right angles to that of the diverticulum in which it lay. It weighed just over half an ounce.

Neither in recorded cases nor in museum specimens have I come across any instance in which an encj^sted calculus had occupied the apex of the bladder. All the records I have found refer to basal or lateral sacculi, such as are commonly associated with enlarged prostate and chronic cystitis. This is so, for instance, in all the cases of encysted calculus included in the late Sir Henry Thompson's series of over 800 cases, the specimens of which are now in the museum of the Royal College of Surgeons of England. From the position and relations of the diverticulum this case appears to be an example of persistent patency of the lower end of the urachus, with calculus formation following, presumably on the accidental lodgment of a small concretion in it.

"While urachal cysts are much commoner in the female than in the male, a patent condition of the urachus leading to urinary umbilical fistula is much commoner in the male."

A Patent Urachus; Vesical Calculi; Sac-like Dilatations in the Urachus Containing Urinary Calculi; Removal of All the Calculi; Recovery. — During the meeting of the Southern Surgical and Gynecological Association held in Cincinnati on December 13, 1915, the President, Dr. Bacon Saunders, of Fort Worth, Texas, told me of the following interesting case that came under his care several years ago.

The patient was a boy about eleven years of age. He had had all the classic symptoms of stone in the bladder since infancy. Examination disclosed a fistulous opening at the umbilicus through which escaped quantities of foul-smelling urine. On a line from the umbilicus to the pubic region were five nodules ranging in size from a hazelnut to an almond.

A number of small calculi, resembling prostatic stones were removed from the bladder. An incision was made over each of the nodules in the mid-line below the umbilicus and a stone removed from each. These stones were of the same character as those found in the bladder. Urine escaped from the multiple openings for a while, but these openings eventually all closed, and the boy made a satisfactory recovery.


CALCULI ASSOCIATED WITH URACHAL REMAINS.


625


REMOVAL OF VESICAL STONES THROUGH THE UMBILICAL OPENING.

In the chapter on Congenital Umbilical Urinary Fistula (p. 507) I have quoted the well-known case of Paget and Bowman. The patient, John Conquest, an iron founder, forty years old, had had a urinary fistula at the umbilicus since birth. Paget detected a stone in the bladder. The umbilical opening being rather large, he introduced a finger, engaged the stone in the urachus, and brought it out through the umbilicus. This stone was irregularly ring-shaped, having developed around a curled-up hair (Fig. 221, p. 507). It was by getting the tip of his finger into the central hole in the stone that he was enabled to remove it by this route.

Nicaise refers to a case published by Faivre in the Journal de mecl. et chir., 1786. The patient, a small girl of twelve, had for four years passed her urine from the umbilicus. The urethra was obstructed by a calculus. Finally there was considerable engorgement of the surface of the abdomen, due to the urine escaping into the cellular tissue. Faivre entered the bladder through the umbilicus and removed the stone. A sound was introduced into the urethra, and the child made a complete recovery.

If urinary calculi develop in the urachus, they will naturally be found near the bladder, as indicated in Fig. 255.



Fig. 255. — A Patent Urachus Containing a Vesical Calculus. (Schematic.) The urachus is recognized as an open channel from the upper part of the bladder to the umbilicus. Just above the bladder it contains a spheric and rough vesical calculus. In the upper part of the umbilicus is a small umbilical hernia.


OTHER CALCULI IN THE UMBILICAL REGION.

On p. 337 we have discussed at length the escape of gall-stones at the umbilicus. The following cases, reported by Kostlin and by Bramann, while not strictly germane to the subject, are of considerable interest.

Communication Between the Gall-bladder and the Urinary Bladder, With Escape of Gall-stones Through the Urinary Tract. — Kostlin* cites the case of a patient whose history Faber had already reported in an inaugural dissertation. This woman first had

  • Kostlin, O.: Verbindung zwischen Gallenblase und Harnblase, mit Abgang von Gallensteinen durch die Harnwege. Deutsche Klinik, 1864, xvi, 116.

41


626 THE UMBILICUS AND ITS DISEASES.

trouble when thirty-five yea,vs of age. In the autumn of 1834 she had signs of peritonitis, with pains in the umbilical region. Later the pain was more marked above the symphysis. In October, 1835, she was again ill, this time with bronchopneumonia. On the fourth day there was pain over the symphysis, and the urine was blackish green (bile). The patient soon passed gall-stones, large and small, by the urethra. The gall-stones were examined chemically. The patient was kept under observation for years. She died, at sixty-three, with symptoms of bronchial catarrh and asthma.

Autopsy. — The liver was normal, but the entire organ was situated lower than usual. From the middle of the lower edge a rounded cord extended to the base of the bladder, passing in front of the intestine and pushing the transverse colon downward and to the left. The cord consisted of two portions — the lower and larger half was 1" 7.6"' (about one and three-fourth inches long) and was composed of the urachus. The upper, shorter half belonged to the lower portion of the gall-bladder. The entire length of this was 3" 1.5"' (about 3}4 inches long). The route which the bile and gall-stones traveled was from the gall-bladder through the urachus to the urinary bladder.

Kostlin mentions a similar case, reported by Pelletan.* In this case there was no autopsy.

Probably a Distended Gall-bladder Opening at the Umbilicus.! — The patient was a single woman, sixty-three years of age. She had had typhoid when thirteen. At the age of forty-five she had had sudden abdominal pain, accompanied by high fever, and there was much discomfort in the gall-bladder region. There was a tendency to vomit, and the abdomen was somewhat swollen. A tumor could be made out above and to the right of the umbilicus. It was the size of a fist and painful. The tumor persisted, grew slowly, and tended to pass more and more downward toward the symphysis.

Two years later a large quantity of foul pus escaped from the umbilicus. Pus continued to be discharged in varying amounts from the umbilicus for about sixteen years. The patient was otherwise in good condition.

On admission the abdomen was found to be slightly distended. The skin surrounding the umbilicus was covered with crusts, exfoliated epithelium, and small cysts. The umbilicus was drawn in, and in its center was a small discharging fistula. The escaping pus was foul-smelling. On palpation exactly in the mid-line a long, egg-shaped tumor was noted. At the umbilicus this was 5 cm. broad. It extended almost to the symphysis, and in its lower portion it was 7 to 8 cm. wide. The tumor lay distinctly behind the abdominal wall, and only in the neighborhood of the umbilicus was it intimately attached. In the lower part it was somewhat movable. On pressure it was found to be of dense consistence. A sound could be passed 12 cm. toward the symphysis and the cavity widened out. Calculi were detected at the bottom. Urination was always normal.

Operation. — The abdominal wall was incised for 8 cm. from the umbilicus downward. Four faceted calculi the size of pigeon's eggs were removed, and the tract was curetted out. Healing occurred after three months, but in the mean time it was necessary to curet the cavity several times. After several vain attempts Bramann found in some places many layers of squamous epithelium.

  • Pelletan: Jour, de chimie med., 2. ser., ii, Nos. 11 et 12.

t Bramann, F.: Arch. f. klin. Chir., 1887, xxxvi, 996.


CALCULI ASSOCIATED WITH URACHAL REMAINS. 627

Microscopic examination of the calculi yielded cholesterin and bile-pigment ; no urinary salts.

[The condition might well be explained by a gall-bladder extending into the pelvis and at the same time becoming adherent to the umbilicus. Everything points to this explanation, although Bramann considered the case to be one of open urachus. — T. S. C]


LITERATURE CONSULTED ON URACHAL CONCRETIONS AND URINARY CALCULI

ASSOCIATED WITH URACHAL REMAINS. Arrou: Kyste suppure de l'ouraque. Bull, et Mem. de la Soc. de chir., Paris, 1910, xxxvi, 832. Bramann, F.: Zwei Falle von offenem Urachus bei Erwachsenen. Arch. f. klin. Chir., 1887,

xxxvi, 996. Civiale, J.: Traite de l'affection calculeuse, Paris, 1838, 257.

Dykes, C: Patent Urachus and Encj r sted Urinary Calculi. The Lancet, 1910, i, 566. Hoffmann, C. E. E.: Zur pathologisch-anatomischen Veranderung des Harnstrangs. Arch, der

Heilkunde, 1870, xi, 373. Kostlin, O.: Verbindung zwischen Gallenblase und Harnblase, mit Abgang von Gahensteinen

durch die Harnwege. Deutsche Klinik, 1864, xvi, 116. Ledderhose, G.: Chir. Erkrankungen des Nabels. Deutsche Chirurgie, 1890, Lief. 45 b. Luschka, H.: Ueber den Bau des menschlichen Harnstranges. Arch. f. pathologische Anatoniie

u. Physiologie u. f. klin. Med., 1862, xxiii, 1. Monod, J.: Des fistules urinaires ombilicales dues a la persistance de l'ouraque. These de Paris,

1899, No. 62. Nicaise: Ombilic. Diet, encyclopedique des sciences medicales, Paris, 1881, 2. ser., xv, 140. Phillips, B.: Persistence of the Urachus. Todd's Cyclopaedia of Anatomy and Physiology,

1835, i, 393. Rokitansky, C: Pathologische Anatomie. 3. Aufl., Wien, 1861, hi, 372. Simon, C: Quels sont les phenomenes et le trait ement des fistules urinaires ombilicales. These

de Paris, 1843, No. 80. Suchannek, H.: Beitrage zur Kenntnis des Urachus. Inaug. Diss., Konigsberg, 1879. Veiel, E. : Die Metamorphose des Urachus. Diss., Tubingen, 1862. Vosburgh, H. D. : Patent Urachus with Calculus. Medical Record, New York, 1877, 606. Weiser, W. R.: Cysts of Urachus. Annals of Surg., 1906, xliv, 529. Worster, J.: Case of Vesico-abdominal Fistula of Fourteen Years' Standing. Medical Record.

1877, xii, 196. Wutz, J. B.: Ueber Urachus und Urachuscysten. Virchows Arch., 1883, xch, 387.



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)

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