Book - Umbilicus (1916) 5

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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 V. Granulation Tissue or Granuloma of the Umbilicus

General description. Differential diagnosis. Treatment.

Without doubt this is the most frequent umbilical abnormality met with, and probably every physician in general practice has at some time noted the presence of a small red mass in the umbilical depression shortly after the cord has come away.

In England attention has been drawn to the subject by Millar, in Germany by Ledderhose, Pernice, and others; in France the subject has been interestingly handled by Lannelongue and Fremont, Forgue and Riche, and by Florentin; in the American literature we find articles on the subject by Holt and by de Villiers.

Immediately or shortly after the cord comes away, a slightly purulent or yellowish discharge may be noted at the umbilicus, and on separation of the umbilical folds a small red tumor mass is seen on the umbilical floor. It is usually the size of a pea, more or less pedunculated, light or dark red in color, has a rather smooth, glistening surface, and, although sometimes firm, is generally soft and mushy and may bleed readily. It is nothing more than typical granulation tissue. It represents that portion of the umbilical cord distal to the ligature, which in the process of separation has not completely come away.

On histologic examination the entire mass is found to consist of young granulation tissue. Its blood capillaries are very abundant and scattered throughout the field are many small round-cells. In 4 out of 27 cases collected by Pernice the surface of the granulation was partly covered over with a delicate epithelium.

Millar has pointed out that the superficial cells of the granulation tissue may be so flattened that they produce a quasi-epithelial covering.

These small tumors, consisting of granulation tissue, were formerly often confused with another small umbilical tumor found immediately or shortly after the cord has come away. These nodules, however, are very firm, are not apt to disappear, and are remnants of the omphalomesenteric duct. With a little practice the two varieties can be readily differentiated clinically. The chief points of difference are discussed in the chapter on Umbilical Polyp (c/. p. 124).

I append the report of a case of a small granulation tumor at the umbilicus that came under my notice in consultation with Dr. George L. Wilkins, December 31, 1910:

Granuloma or Granulation Tissue at the Umbilicus. —Baby A. The child was two months old. The mother said that, when the cord was tied, the midwife noted that it was very much larger than usual at the umbilicus. A Her the cord came away there was an abundant discharge of what the mother said was corruption. This had been very free until a short time previously. The umbilical margins were raised fully 2 mm. from the surface (Fig. 65). In the center was a little red mass, globular in form, which showed a whitish mottling, just as if there were a mucosa with areas of skin covering it at certain points. It lay directly in the center of the umbilicus. Dr. Wilkins had from time to time applied nitrate of silver. The nodule had diminished somewhat in size. It was

116


GRANULATION TISSUE OR GRANULOMA OF THE UMBILICUS. 117

removed without much difficulty, and found to be exceedingly friable. Histologic examination showed that it was composed entirely of granulation tissue. There was no evidence at any point of an epithelial covering.

Treatment . — In some cases it will suffice to snip off the excessive granulation tissue with the scissors, and then apply an astringent. On account of the smallness of the umbilical opening it is usually better merely to apply an astringent and then keep the parts dry. The granulation tissue then soon dries up and drops off. It is sometimes possible to tie off the granulation mass, but, as a rule, it is too mushy.


Fig. 65. — Ax Umbilical Gra.nttla.tiom. The umbilical ring is unusually prominent, protruding at least 2 mm. above the abdominal wall. In the center is a small, globular, red mass. It was very friable, was readily removed, and did not recur. On histologic examination it was found to consist essentially of young granulation tissue rich in blood-capillaries. It contained no epithelial elements.


LITERATURE CONSULTED ON GRANULATION TISSUE OR GRANULOMA OF THE

UMBILICUS.

Florentin, P.: Fungus de l'ombilic, chez le nouveau-ne et chez 1' enfant. These de Nancy, 1908-9, Xo. 22.

Forgue et Riche: Montp?ll. med., 1907, xxiv, 145-169.

Holt, L. Emmett: Umbilical Tumor in an Infant formed by Prolapse of the Intestinal Mucous Membrane of Meckel's Diverticulum. Med. Record, 1888, xxxiii, 431.

Lannelongue et Fremont: De quelques varietes de tumeurs congenitales de l'ombilic et plus specialement des tumeurs adenoides diverticulaires. Arch. gen. de med., 1884, 7e ser., xiii, 36.

Ledderhose, G.: Deutsche Chirurgie, 1890, Lieferung 45b.

Millar, W. Heptinstall: Umbilical Polypi. St. Thomas's Hospital Reports, New Series, xix, 287.

Pernice, L.: Die Xabelgeschwlilste, Halle, 1892.

de Villiers, J. H.: The Nature of Umbilical Growths of Infants and Young Children. Pediatrics, 1897, hi, 337.



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 23) Embryology Book - Umbilicus (1916) 5. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Book_-_Umbilicus_(1916)_5

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