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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.
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Embryology, Anatomy, and Diseases of the Umbilicus together with Diseases of the Urachus
By
Thomas Stephen Cullen
Associate Professor of Gynecology in the Johns Hopkins University
Assistant Visiting Gynecologist to the Johns Hopkins Hospital
Illustrated By
Max Brodel
W. B. Saunders Company, Philadelphia And London, 1916
This book is affectionately dedicated to my Mother Mary Cullen
Daughter of the late Rev. Thomas and Mary Greene
Born on July 12, 1841, at Polminick, near
Penzance, Cornwall, England
Preface
During the summer of 1904 I saw a case of cancer of the umbilicus with Dr. Jacob L. Winner. Up to that time I had thought that hernia was practically the only lesion to be noted in this locality. The patient did well for a time, but later large intra-abdominal tumors could be felt and finally he died. Xo autopsy was obtained. Histologic examination of the umbilical growth showed that it was an adenocarcinoma.
I was at a loss to explain the presence of glands in this position, and a cursory
examination of the text-books failed to elucidate the matter. I could not rid myself of the desire to find out definitely just how an adenocarcinoma could exist in the
umbilicus, and several years later, when other and more pressing problems had been
completed, I carefully searched the literature for cases of cancer of the umbilicus
and was amazed to find the records of many instances.
In the majority of the cases the umbilical growth was secondary to a cancer of the stomach, gall-bladder, intestine, or ovary. Cases of primary adenocarcinoma and of squamous-cell carcinoma of the umbilicus occur, but they are very rare.
During this study I encountered a wealth of material dealing with the omphalomesenteric duct. We have long been familiar with Meckel's diverticulum, but two facts, that the omphalomesenteric duct may be patent throughout its entire extent at birth, and that remnants of the outer end of the duct may give rise to the small umbilical polyps sometimes noted after the cord drops off, have not been commonly appreciated.
The literature is rich in records of devastating infections that prevailed before the era of asepsis. These occurred generally in hospitals, and most often when an epidemic of puerperal sepsis was rampant among the mothers. The descriptions of some of them are intensely graphic, and from the detailed reports of the individual cases one can obtain a wonderful picture of the terminal infections occurring in these infants.
I found a somewhat extensive literature on dermoids of the umbilicus, but on analyzing the cases was obliged to conclude that the majority of these growths represented nothing more than inflammations due to irritation exerted by an umbilical concretion. It was the presence of caseous material and the admixture of wool from the patient's clothing that had led to the erroneous diagnosis.
I found records of cases of Paget's disease, diphtheria, and syphilis of the umbilicus. There is also an extensive literature on the escape of intra- and extraabdominal fluid, usually pus, through the umbilicus, and many cases of umbilical fistula are recorded.
Many umbilical tumors have been reported, some benign, others malignant. I was especially interested in one group of cases. These tumors were small; they always occurred in women; they tended to swell at the menstrual period, and some urachus have been collected, the cases classified, and the appropriate methods of treatment outlined. I trust that this work may help the general practitioner, the pediatrician, and the surgeon to treat more satisfactorily lesions of this heretofore relatively unknown region, unknown, although up to the daj r of birth it is on the main highway between the mother and the child.
Thomas S. Cullen.
The Johns Hopkins Hospital, May, 1916.
Contents
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 |
- Embryology of the Umbilical Region
- Anatomy of the Umbilical Region
- Umbilical Infections in the New-born
- Umbilical Hemorrhage
- Granulation Tissue or Granuloma of the Umbilicus
- Remnants of the Omphalomesenteric Duct
- Congenital Polyps; Fistul.e or Cystic Dilatations at the Umbilicus; with a Mucosa More or Less Similar to that of the Pyloric Region of the Stomach, and Secreting an Irritating Fluid Bearing a Marked Resemblance to Gastric Juice. Persistence of the Outer Portion of the Omphalomesenteric Duct
- Meckel's Diverticulum
- Intestinal Cysts
- A Patent Omphalomesenteric Duct
- The Patent Omphalomesenteric Duct (continued)
- Prolapsus of the Bowel through a Patent Omphalomesenteric Duct
- Cysts in the Abdominal Wall Due to Remnants of the Omphalomesenteric Duct
- Persistence of the Omphalomesenteric Vessels
- Umbilical Concretions Associated with Inflammatory Changes in the Abdominal Wall
- Abscess in the Subumbilical Space
- Paget's Disease of the Umbilicus
- Diphtheria of the Umbilicus . Syphilis of the Umbilicus; Tuberculosis of the Umbilicus; Atrophic Tuberculid commencing at the Umbilicus
- The Escape of Retroperitoneal and Abdominal Fluid from the Umbilicus; the Opening of an Appendix Abscess at the Umbilicus. Abscess of the Liver Opening at the Umbilicus; Peritonitis with the Escape of Pus from the Umbilicus; the Piecemeal Removal of a Suppurating Ovarian Cyst through the Umbilicus
- Fecal Fistula at the Umbilicus
- The Escape of Round Worms from the Umbilicus
- The Escape of Various Foreign Substances from the Umbilicus
- Umbilical Tumors
- Adenomyoma of the Umbilicus
- Carcinoma of the Umbilicus
- Sarcoma of the Umbilicus
- Umbilical Hernia
- The Urachus
- Congenital Patent Urachus
- Remnants of the Urachus
- Urachal Remnants Producing Tumors between the Umbilicus and Symphysis
- Large Urachal Cysts
- Abscesses in the Anterior Abdominal Wall between the Umbilicus and Symphysis Due to Infection of Urachal Remains or of Urachal Cysts
- Urachal Cavities between the Symphysis and Umbilicus Communicating with the Bladder or Umbilicus or with Both
- Acquired Urinary Fistula at the Umbilicus
- Urachal Concretions and Urinary Calculi Associated with Urachal Remains
- Malignant Changes in the Urachus
- Bleeding from the Urachus into the Bladder
- Tuberculosis of the Patent Urachus
List of Illustrations
1. Sagittal Section Showing a Very Early Stage in the Formation of the Umbilicus and allantois 2
2. A More Advanced Stage in the Formation of the Umbilical Region 2
3. A Composite Picture Showing the Formation of the Umbilicus in an Embryo 3
4. A Diagrammatic Representation of a Human Embryo, about 3.5 mm. Long, Show ing the Effect of the Expanding Amnion upon the Yolk-sac and Body-stalk ... 4
5. Sagittal View of a Human Embryo 5 mm. in Length 5
6. Anterior View and Transverse Section of a Human Embryo 7 mm. Long, Showing
the Umbilical Region 6
7. Sagittal Section of the Umbilical Region in an Embryo 7 mm. in Length 7
8. Sagittal View of the Umbilical Region of a Human Embryo 10 mm. in Length 8
9. Graphic Reconstruction of the Umbilical Cord of a Human Embryo 12.5 mm. in
Length 9
10. Anterior View of the Umbilical Cord of a Human Embryo 18 mm. in Length 10
11. Sagittal Section of the Umbilical Region in a Human Embryo 23 mm. in Length .. 11
12. A Graphic Reconstruction of the Umbilical Region of a Human Embryo 3 cm.
Long 12
13. Sagittal Section of the Umbilical Region in a Human Embryo 4.5 cm. in Length .. 13
14. A Graphic Reconstruction of the Umbilical Region of a Human Embryo 4.5 cm.
in Length as Viewed from within the Abdomen 14
15. Sagittal View of a Graphic Reconstruction of the Umbilical Region of a Human
Embryo 5.2 cm. in Length 15
16. Intra-abdominal View of the Umbilical Region of a Human Embryo 6.5 cm. in
Length 17
17. Intra-abdominal View of the Umbilical Region in a Human Embryo 7.5 cm. Long . . 18
18. Intra-abdominal View of the Umbilical Region in a Human Embryo 9 cm. in
Length 18
19. Intra-abdominal View of the Umbilical Region in a Human Embryo 10 cm. in
Length 19
20. Intra-abdominal View of the Umbilical Region in a Human Embryo 12 cm. Long . . 19
21. Intra-abdominal View of the Umbilical Region in a Human Embryo 12 cm. in
Length 20
22. Intra-abdominal View of the Umbilical Region in a Human Embryo 12 cm. in
Length 21
23. Cross-section of the Umbilical Cord at the Umbilicus in a Human Embryo 12 cm.
in Length 22
24. Internal View of the Umbilical Region in a Human Embryo 15 cm. Long 23
25. A Composite Representation of Abnormal Umbilical Structures, Based on the
Work of Keibel, Lowy, and Others 24
26. A Composite Representation of Abnormal Umbilical Structures, Based on the
Work of Keibel, Lowy, and Others 24
27. A Composite Representation of Abnormal Umbilical Structures, Based on the
Work of Keibel, Lowy, and Others 24
28. The Umbilical Region in a Fetus about Five Months Old Viewed from the Left . . 25
29. Side and Posterior Views of the Umbilical Region in a Fetus of Six to Seven
Months 25
30. Three Diagrams of the Umbilical Ring and Its Significance in the Development
of Ventral Hernia 27
XV
XVI LIST OF ILLUSTRATIONS
Fig. Page
31. The Appearance of the Yolk-sac (Umbilical Vesicle) in a Pregnancy, with the
Embryo 5.5 cm. Long 28
32. The Umbilical Region, the Cord, and the Placenta at Term 29
33. A Diagrammatic Representation of the Umbilical Region of a Fetus at Term .... 32
34. Normal Umbilicus according to Catteau 35
35. A Type of Umbilical Region in the Adult, Viewed from Within 44
36. A Frequent Type of the Umbilical Region in the Adult, Viewed from Within .... 44
37. The Umbilical Region of an Adult, Viewed from Within 45
38. Classic Type of Umbilicus 47
39. Disposition of the Vascular Cords (Usual Type) 48
40. Vascular Cords of the Anastomosing Type, Noted 7 Times in 50 Cases 48
41. Vascular Cord Type, Noted 5 Times in 50 Cases 49
42. Vascular Cords, Noted 5 Times in 50 Cases, Completely Filling the Umbilical
Ring 49
43. Vascular Cords, Noted 3 Times in 50 Cases 49
44. Vascular Cords, Noted in 2 out of 50 Cases 50
45. Umbilical Fascia. Peritoneum in Place 52
46. Umbilical Fascia and Umbilical Mesentery 52
47. Reduplication of the Linea Alba. Peritoneum Removed 52
48. Atrophy of the Umbilical Fascia, Posterior View 53
49. Formation of a Mesentery. Peritoneum in Place 53
50. Mesentery of the Urachus and of the Umbilical Arteries 53
51. Adipose Fringes. From a Well-developed Young Woman. Peritoneum in Place 54
52. Adipose Fringes in a Stout Subject. Peritoneum in Place 54
53. Peritoneal Diverticula. Peritoneum in Place 55
54. Peri-umbilical Fossettes. Peritoneum in Place 55
55. Ovarian Pedicle Passing from Uterus out through a Hernial Ring in the Ab dominal Wall 57
56. Extra-abdominal Multilocular Fibrocystoma of the Ovary 5S
57. An Extra- abdominal Multilocular Fibrocystoma 59
58. Superficial Lymphatics of the Umbilical Region 64
59. The Deep Umbilical Lymphatics as Seen from the Peritoneal Side 65
60. The Umbilical Vessels about the Time of Birth 72
61. The Umbilical Vessels in the Adult 72
62. 63. Method of Treating the Umbilical Stump at Birth 98
64. Nature's Method of Checking Bleeding from the Umbilical Arteries 107
65. An Umbilical Granulation 117
66. The Gradual Atrophy of the Omphalomesenteric Duct 121
67. An Umbilical Polyp Connected with Meckel's Diverticulum by a Fibrous Cord . . 121
68. An Umbilical Polyp Attached to the Small Bowel by a Fibrous Cord 121
69. An Umbilical Polyp on the Prominent Part of an Umbilical Hernia : . . 123
70. A Polypoid Outgrowth from the Umbilicus 129
71. Tubular Glands from the Umbilical Polyp Shown in Fig. 70 129
72. A Diverticular Tumor at the Umbilicus 132
73. A Glandular Tumor from the Umbilicus 132
74. A Glandular Growth at the Umbilicus 133
75. Section in the Long Axis of a Small Umbilical Growth 134
76. Adenoma of the Umbilicus 135
77. Ax Umbilical Polyp Attached to a Meckel's Diverticulum by a Fibrous Cord. 138
78. Ax Umbilical Polyp Attached to a Meckel's Diverticulum by a Fibrous Cord . . . 138
79. An Umbilical Polyp 139
80. A Small Intestinal Polyp Almost Fillingthb Umbilical Depression 139
81. An Umbilical Polyp 140
82. Portion of an Intestinal Polyp Partially Filling the Umbilical Depression .... 141
83. Transverse Section op a Pseudopyloric Congenital Fistula at the Umbilicus . . . . 149
LIST OF ILLUSTRATIONS XV11
Fia. Fage
84. High-power Picture op a Fistulous Tract at the Umbilicus, Showing Glands Re sembling those of the Pylorus 150
85. An Umbilical Fistula Lined with Mucosa Resembling that of the Stomach 150
86. Appearance of the Umbilical Depression in von Rosthorn's Case 152
87. Gastric Mucosa at the Umbilicus 153
88. Appearance of the Umbilicus After Removal of the Stomach Mucosa Seen in
Fig. 87 154
89. Persistence of the Outer End of the Omphalomesenteric Duct 156
90. Atrophy of the Inner End of the Omphalomesenteric Duct 156
91. A Long Umbilical Polyp as a Remnant of the Omphalomesenteric Duct 156
92. Meckel's Diverticulum 159
93. A Meckel's Diverticulum Attached to the Abdominal Wall at the Umbilicus. . 160
94. An Abnormally Large Meckel's Diverticulum 161
95. A Meckel's Diverticulum with a Lobulated Extremity 161
96. A Meckel's Diverticulum with Hernial Protrusions from Its Surface 162
97. A Short Meckel's Diverticulum Springing from the Mesenteric Attachment . . 163
98. An Accessory Pancreas in the Tip of Meckel's Diverticulum 163
99. A Meckel's Diverticulum Completely Tying off a Loop of Small Bowel 164
100. A Diverticulum Tying Off a Loop of Small Bowel 165
101. Strangulation of a Meckel's Diverticulum Causing Volvulus of the Ileum. . . . 166
102. Fatal Intestinal Obstruction Due to the Passage of the Bowel through a
Hole in the Mesentery of a Meckel's Diverticulum .170
103. Inversion of a Meckel's Diverticulum into the Lumen of the Bowel 171
104. A Well-developed Loop of Small Bowel in a Dermoid Cyst of the Ovary 175
105. An Intestinal Cyst 176
106. An Intestinal Cyst Attached to the Umbilicus by a Pedicle but not Connected
with the Bowel 176
107. Volvulus of Meckel's Diverticulum 177
108. An Intestinal Cyst Developing from Meckel's Diverticulum 178
109. Intestinal Cysts in the Abdominal Cavity 182
1 10. An Intramesenteric Cyst 183
111. A Patent Omphalomesenteric Duct 190
112. A Patent Omphalomesenteric Duct with a Polypoid Formation at the Umbilicus . 190
113. A Very Short Omphalomesenteric Duct 190
114. A Patent Omphalomesenteric Duct with a Polyp- like Formation at the Umbil icus 190
1 15. A Patent Omphalomesenteric Duct 192
116. A Patent Omphalomesenteric Duct 193
1 17. A Patent Omphalomesenteric Duct 197
118. A Patent Omphalomesenteric Duct 197
119. A Patent Omphalomesenteric Duct 202
120. A Patent Omphalomesenteric Duct 205
121. A Patent Omphalomesenteric Duct 206
122. Part of a Patent Omphalomesenteric Duct 206
123. Intestinal Mucosa Covering the Cutaneous or Umbilical End of a Patent Om phalomesenteric Duct 207
124. An Umbilical Polyp and a Fibrous Nodule at the Umbilicus. There was Origin ally a Patent Omphalomesenteric Duct 209
125. Longitudinal Section through the Entire Center of a Partially Closed Om phalomesenteric Duct 209
126. A Patent Omphalomesenteric Duct 211
127. A Patent Omphalomesenteric Duct Opening at the Base of the Umbilical Cord . . 216
128. A Patent Omphalomesenteric Duct 216
129. A Patent Omphalomesenteric Duct as Seen from the Abdominal Cavity 216
130. Inversion of the Bowel through a Patent Omphalomesenteric Duct Opening on the Side of the Umbilical Cord 219
131. A Patent Omphalomesenteric Duct of Large Diameter 224
132. Commencing Prolapsus of Small Bowel through a Patent Omphalomesenteric Duct 224
133. Partial Prolapsus of the Small Bowel through the Omphalomesenteric Duct . . . 224
134. Prolapsus of the Small Bowel through the Patent Omphalomesenteric Duct .... 224
135. Complete Prolapsus of the Bowel through the Patent Omphalomesenteric Duct 225
136. Prolapsus of the Small Bowel through the Patent Omphalomesenteric Duct, and an Umbilical Hernia between the Loops of Prolapsed Bowel 225
137. Prolapse of the Small Bowel through an Open Omphalomesenteric Duct 227
138. Prolapsus of the Bowel through a Patent Omphalomesenteric Duct 228
139. Prolapsus of the Bowel through a Patent Omphalomesenteric Duct, with Sec ondary Complications 229
140. Prolapsus and Inversion of the Intestine through a Patent Omphalomesenteric Duct 230
141. Prolapsus of the Bowel through the Patent Omphalomesenteric Duct 232
142. A Small Cyst of the Umbilicus Due to a Remnant of the Omphalomesenteric Duct 238
143. Small Cyst of the Abdominal Wall Due to a Remnant of the Omphalomesenteric Duct 238
144. A Small Intestinal Cyst Lying between the Peritoneum and the Recti 240
145. An Omphalomesenteric Duct Originating from the Concave Side of the Bowel and Attached to the Umbilicus by a Fibrous Cord 243
146. A Remnant of an Omphalomesenteric Duct Causing Fatal Intestinal Obstruction 245
147. A Small Umbilical Concretion 249
148. Acute Inflammation of the Umbilicus Due to an Accumulation of Sebaceous Material 249
149. Cholesteatoma from the Umbilicus in Case 1 251
150. Cholesteatoma from Case 2 251
151. A Connective-tissue Projection Really Representing a Small Fibroma in the Floor of the Umbilicus 252
152. Enlargement of Fig. 151 252
153. Subumbilical Phlegmon 262
154. The Subumbilical Space 264
155. Paget's Disease of the Umbilicus 270
156. Paget's Disease of the U/mbilicus 270
157. Paget's Disease of the Umbilicus 271
158. Paget's Disease of the Umbilicus 274
159. The Appearance in a Case of Paget's Disease of the Umbilicus After Treatment with Radium 275
160. Syphilis of the Umbilicus 284
161. Atrophic Tuberculid Starting at the Umbilicus 286
162. Leakage from an Abdominal Aneurysm Producing a Temporary Abdominal Tumor; Subsequent Escape of the Blood into the Right Renal Pocket 288
163. The Manner in Which a Periprostatic Abscess may Occasionally Rupture at the Umbilicus 289
164. Escape of Pleural Fluid from the Umbilicus 289
165. The Opening of a Broad Ligament Abscess at the Umbilicus 290
166. Abdominal Pregnancy with Spontaneous Escape of Liquor Amnii from the Umbilicus 348
167. Small Papilloma in the Umbilical Depression 365
168. A Shall Umbilical Tumor Containing Glands and Stroma Identical with Those of the Uterine Mucosa 376
169. Glands from a Small U\iisiLirALTuMOR 377
170. Typical Uterine Mucosa in a Small Umbilical Tumor. An Enlargement of Area B in Fig. 168 378
171. Glands in a Small Umbilical Tumor 379
172. Dilated Glands in a Small Umbilical Tumor 380
173. Dichotomous Branching of Glands in a Small Umbilical Tumor 381
174. Uterine Glands in an Umbilical Tumor 381
175. Gland Hypertrophy in a Small Umbilical Tumor 382
176. A Tumor of the Umbilicus Composed Partly of Hypertrophic Sweat-glands 383
177. Uterine Mucosa in an Umbilical Tumor 384
178. A Small Umbilical Tumor Containing Numerous Glands 388
179. Glands in a Small Umbilical Tumor 389
180. An Adenomyoma in the Abdominal Wall Near the Anterior Iliac Spine 394
181. A Small Umbilical Tumor Containing Glands Similar to Those of the Body of the Uterus 396
182. Adenomyoma of the Umbilicus 397
183. A Group of Sweat-glands in an Umbilical Tumor 398
184. Appearance of the Carcinomatous Umbilicus After Removal 424
185. Carcinoma of the Umbilicus Secondary to Carcinoma of the Ovaries 432
186. A Malignant Growth of the Umbilicus, Apparently a Carcinoma Secondary to Some Abdominal Growth 439
187. Adenocarcinoma of the Umbilicus Secondary to an Intra-abdominal Growth .... 440
188. Adenocarcinoma of the Umbilicus 441
189. A Section Showing Carcinoma of the Right Inguinal Glands 442
190. Secondary Carcinoma of the Umbilicus 443
191. Telangiectatic Myxosarcoma of the Umbilicus 450
192. Appearance of the Umbilicus After Removal of the Tumor Shown in Fig. 191. . 450
193. Myxosarcoma of the Umbilicus 451
194. Telangiectatic Myxosarcoma Projecting from the Right Side of the Umbilicus . . 452
195. A Telangiectatic Myxosarcoma 452
196. A Case of Congenital Umbilical Hernia 460
197. An Amniotic Hernia 462
198. Several Loops of Bowel Which Lay Outside the Umbilicus and were Nipped Off During Fetal Life. The Child Lived a Short Time After Birth 464
199. A Serous Umbilical Hernia 469
200. Freeing the Umbilical Hernial Sac from the Abdomen 472
201. Closure of the Hernial Opening at the Umbilicus 473
202. Closure of the Hernial Opening at the Umbilicus 474
203. An Umbilical Hernia Associated with Marked Prolapsus of the Abdominal Wall 475
204. An Umbilical Hernia and a Markedly Pendulous Abdomen in a Patient Weighing 464 Pounds 476
205. The Abdominal Scar After the Removal of a Very Large Area of Fat 477
206. An Umbilical Cyst 478
207. Exstrophy of the Bladder Opening at or Near the Umbilicus 482
208. Exstrophy of the Bladder. A side View of the Case Depicted in Fig. 207, Showing the Relative Distance from the Symphysis to the Opening in the Abdominal Wall : 483
209. Exstrophy of the Bladder 483
210. Escape of Urine from the Umbilicus When the Inner Urethral Orifice Is Blocked by a Membrane 488
211. A Patent Urachus with a Mushroom-like Projection at the Umbilicus 489
212. A Patent Urachus with a Penile Projection at the Umbilicus 489
213. The Appearance of the Umbilicus in a Case in Which both a Patent Omphalomesenteric Duct and a Patent Urachus Existed 493
214. Cross-section of the Patent Omphalomesenteric Duct and of the Patent Urachus in the Same Child 493
215. A Picture of the Child Three Weeks After Removal of a Patent Omphalomesenteric Duct and a Patulous Urachus 494
216. A Patent Urachus 497
217. A Urachus Open from Bladder to Umbilicus 498
218. An Open Urachus 499
219. Escape of Urine from the Umbilicus Due to a Patent Urachus 502
220. A Patent Urachus with a Penile Projection at the Umbilicus 505
221. A Ring-shaped Vesical Calculus with a Fine Hair in Its Axis 507
222. A Partially Patent Urachus 515
223. A Patent Urachus 517
224. A Portion of a Urachus Seven Times Enlarged, with Numerous Large and Small Dilatations 518
225. Portion of a Urachus Ten Times Enlarged 518
226. Cysts of the Urachus Arranged Like a String of Pearls .- 520
227. Spindle-Shaped Dilatations of the Urachus 520
228. A Small Cyst of the Urachus 532
229. A Patent Urachus 534
230. A Multilocular Cyst of the Urachus 535
231. Section of a Patent Urachus .' 536
232. Transverse Section of a Patent Urachus 537
233. A Small Cyst of the Urachus 538
234. A Diffuse Neuroma of the Bladder 542
235. Cut Surface of the Bladder Showing a Diffuse Neuroma of Its Walls 543
236. A Diffuse Neuroma Forming a Mantle Around the Cavity of the Bladder 544
237. Diagram Showing the Arrested Development of the Genital Tract and the Relation of the Malformed Parts to the Cyst of the Urachus 551
238. Section of the Segment of Urachus Which Passed between the Bladder and the Cyst- wall, as Seen under a Low Power 552
239. The Abdominal Contour in a Case of Very Large Urachal Cyst 558
240. A Urachal Cyst Turned Inside Out and Showing Papillary Masses, Particularly in the Lower Part of the Picture 559
241. Infected Urachal Remains 568
242. An Infected Urachus Opening between the Umbilicus and Bladder 570
243. Urachal Cyst 576
244. A Dilated Urachus Communicating with the Bladder 579
245. Large Accumulation of Urine in a Partially Patent Urachus 579
246. An Infected Urachus Opening at the Umbilicus 580
247. A Patent Urachus Dilated in Its Middle Portion 580
248. Accumulation of a Large Quantity of Urine in a Urachal Pouch 581
249. Fetal Bones Removed from an Old Extra-uterine Pregnancy Sac 584
250. A Phosphatic Deposit on the End of a Long Bone 585
251. A Dilated Urachus Communicating with the Bladder 598
252. Urachal Cyst 599
253. Urachal Cyst 603
254. Urachal Cyst 603
255. A Patent Urachus Containing a Vesical Calculus 625
256. Carcinoma of the Patent Urachus 632
257. A Multilocular and Malignant Cyst of the Urachus 637
258. Giant-cells in the Wall of an Adenocarcinomatous Cyst of the Urachus 638
259. Giant-cells in the Wall of an Adenocarcinoma of the Urachus 639
260. Giant-cells in the Wall of an Adenocarcinomatous Cyst of the Urachus. . .640-641
261. Adenocarcinoma of the Urachus 642
262. A Papillary-like Area i.\ an Adkxocarcinomatous Cystofthe Urachus 643
263. Metastasis from Adenocarcinoma of the Urachus 644
264. An Umbilical Cyst 645
265. \\ aj.i of an Umbilical Cyst 645
266. Giant-cells in the Wall of an Umbilical Cyst 646
267. Tuberculosis of the Urachus 652
268. An Area Suggesting a Tubercle 653
269. A Tubercle from Dr. Eastman's Case of Tuberculosis of the Urachus 654
List of Plates
I. Drawings of Normal Umbilici 40
II. Drawings of Normal Umbilici 41
III. Drawings of Normal Umbilici 42
IV. Drawings of Normal Umbilici 43
V. Cancer of the Umbilicus Apparently Secondary to a Tumor of the Ovary. .434-435
VI. Umbilical Hernia 466-467
VII. Exstrophy of the Bladder 484-485
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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Cite this page: Hill, M.A. (2024, June 5) Embryology Book - Umbilicus (1916). Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Book_-_Umbilicus_(1916)
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