Book - Umbilicus (1916)

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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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This historic 1916 textbook by Cullen describes the umbilical region. Links: PDF version | Internet Archive Modern Notes: placenta Placenta Links: placenta | Lecture - Placenta | Lecture Movie | Practical - Placenta | implantation | placental villi | trophoblast | maternal decidua | uterus | endocrine placenta | placental cord | placental membranes | placenta abnormalities | ectopic pregnancy | Stage 13 | Stage 22 | placenta histology | placenta vascular | blood vessel | cord stem cells | 2013 Meeting Presentation | Placenta Terms | Category:Placenta Historic Embryology - Placenta  1883 Embryonic Membranes | 1907 Development Atlas | 1909 | 1910 Textbook | 1917 Textbook | 1921 Textbook | 1921 Foetal Membranes |1921 human | 1921 Pig implantation | 1922 Single placental artery | 1923 Placenta Review | 1939 umbilical cord | 1943 human and monkey | 1944 chorionic villus and decidua parietalis | 1946 placenta ageing | 1960 first trimester placenta | 1960 monkey | 1972 Placental circulation | Historic Disclaimer

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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

1. Embryology of the Umbilical Region
2. Anatomy of the Umbilical Region
3. Umbilical Infections in the New-born
4. Umbilical Hemorrhage
5. Granulation Tissue or Granuloma of the Umbilicus
6. Remnants of the Omphalomesenteric Duct
7. 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
8. Meckel's Diverticulum
9. Intestinal Cysts
10. A Patent Omphalomesenteric Duct
11. The Patent Omphalomesenteric Duct (continued)
12. Prolapsus of the Bowel through a Patent Omphalomesenteric Duct
13. Cysts in the Abdominal Wall Due to Remnants of the Omphalomesenteric Duct
14. Persistence of the Omphalomesenteric Vessels
15. Umbilical Concretions Associated with Inflammatory Changes in the Abdominal Wall
16. Abscess in the Subumbilical Space
17. Paget's Disease of the Umbilicus
18. Diphtheria of the Umbilicus . Syphilis of the Umbilicus; Tuberculosis of the Umbilicus; Atrophic Tuberculid commencing at the Umbilicus
19. 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
20. Fecal Fistula at the Umbilicus
21. The Escape of Round Worms from the Umbilicus
22. The Escape of Various Foreign Substances from the Umbilicus
23. Umbilical Tumors
24. Adenomyoma of the Umbilicus
25. Carcinoma of the Umbilicus
26. Sarcoma of the Umbilicus
27. Umbilical Hernia
28. The Urachus
29. Congenital Patent Urachus
30. Remnants of the Urachus
31. Urachal Remnants Producing Tumors between the Umbilicus and Symphysis
32. Large Urachal Cysts
33. Abscesses in the Anterior Abdominal Wall between the Umbilicus and Symphysis Due to Infection of Urachal Remains or of Urachal Cysts
34. Urachal Cavities between the Symphysis and Umbilicus Communicating with the Bladder or Umbilicus or with Both
35. Acquired Urinary Fistula at the Umbilicus
36. Urachal Concretions and Urinary Calculi Associated with Urachal Remains
37. Malignant Changes in the Urachus
38. Bleeding from the Urachus into the Bladder
39. 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

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, April 27) Embryology Book - Umbilicus (1916). Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Book_-_Umbilicus_(1916)

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