Book - Umbilicus (1916): Difference between revisions

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| [[File:Mark_Hill.jpg|90px|left]] This historic 1916 textbook by Cullen describes the umbilical region.
| [[File:Mark_Hill.jpg|90px|left]] This historic 1916 textbook by Cullen describes the umbilical region.
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'''Links:''' [[Media:Embryology, anatomy, and diseases of the umbilicus together with diseases of the urachus (1916).pdf|PDF version]] | [https://archive.org/details/embryologyanatom00cull/page/n5 Internet Archive]


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{{Historic Disclaimer}}
{{Historic Disclaimer}}
=Embryology, Anatomy, and Diseases of the Umbilicus together with Diseases of the Urachus=
=Embryology, Anatomy, and Diseases of the Umbilicus together with Diseases of the Urachus=
 
[[File:Cullen1916 titlepage.jpg|thumb|300px]]
By  
By  


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==Contents==
==Contents==
{{Cullen1916 TOC}}
{{Cullen1916 TOC}}
 
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# [[Book - Umbilicus (1916) 1|Embryology of the Umbilical Region]]
# [[Book - Umbilicus (1916) 1|Embryology of the Umbilical Region]]
# [[Book - Umbilicus (1916) 2|Anatomy of the Umbilical Region]]
# [[Book - Umbilicus (1916) 2|Anatomy of the Umbilical Region]]
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==List of Illustrations==
==List of Illustrations==
1. Sagittal Section Showing a Very Early Stage in the Formation of the Umbilicus and allantois 2
[[Book - Umbilicus (1916) Figures|Figures]]


2. A More Advanced Stage in the Formation of the Umbilical Region 2
1. Sagittal Section Showing a Very Early Stage in the Formation of the Umbilicus  and allantois


3. A Composite Picture Showing the Formation of the Umbilicus in an Embryo 3
2. A More Advanced Stage in the Formation of the Umbilical Region


4. A Diagrammatic Representation of a Human Embryo, about 3.5 mm. Long, Show
3. A Composite Picture Showing the Formation of the Umbilicus in an Embryo
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
4. A Diagrammatic Representation of a Human Embryo, about 3.5 mm. Long, Showing the Effect of the Expanding Amnion upon the Yolk-sac and Body-stalk


6. Anterior View and Transverse Section of a Human Embryo 7 mm. Long, Showing
5. Sagittal View of a Human Embryo 5 mm. in Length


the Umbilical Region 6
6. Anterior View and Transverse Section of a Human Embryo 7 mm. Long, Showing the Umbilical Region


7. Sagittal Section of the Umbilical Region in an Embryo 7 mm. in Length 7
7. Sagittal Section of the Umbilical Region in an Embryo 7 mm. in Length  


8. Sagittal View of the Umbilical Region of a Human Embryo 10 mm. in Length 8
8. Sagittal View of the Umbilical Region of a Human Embryo 10 mm. in Length


9. Graphic Reconstruction of the Umbilical Cord of a Human Embryo 12.5 mm. in  
9. Graphic Reconstruction of the Umbilical Cord of a Human Embryo 12.5 mm. in Length


Length 9
10. Anterior View of the Umbilical Cord of a Human Embryo 18 mm. in Length


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. 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. A Graphic Reconstruction of the Umbilical Region of a Human Embryo 3 cm.  
13. Sagittal Section of the Umbilical Region in a Human Embryo 4.5 cm. in Length


Long 12
14. A Graphic Reconstruction of the Umbilical Region of a Human Embryo 4.5 cm in Length as Viewed from within the Abdomen


13. Sagittal Section of the Umbilical Region in a Human Embryo 4.5 cm. in Length .. 13
15. Sagittal View of a Graphic Reconstruction of the Umbilical Region of a Human Embryo 5.2 cm. in Length 15


14. A Graphic Reconstruction of the Umbilical Region of a Human Embryo 4.5 cm.  
16. Intra-abdominal View of the Umbilical Region of a Human Embryo 6.5 cm. in Length


in Length as Viewed from within the Abdomen 14
17. Intra-abdominal View of the Umbilical Region in a Human Embryo 7.5 cm. Long


15. Sagittal View of a Graphic Reconstruction of the Umbilical Region of a Human  
18. Intra-abdominal View of the Umbilical Region in a Human Embryo 9 cm. in Length


Embryo 5.2 cm. in Length 15
19. Intra-abdominal View of the Umbilical Region in a Human Embryo 10 cm. in Length


16. Intra-abdominal View of the Umbilical Region of a Human Embryo 6.5 cm. in
20. Intra-abdominal View of the Umbilical Region in a Human Embryo 12 cm. Long


Length 17
21. Intra-abdominal View of the Umbilical Region in a Human Embryo 12 cm. in  Length


17. Intra-abdominal View of the Umbilical Region in a Human Embryo 7.5 cm. Long . . 18
22. Intra-abdominal View of the Umbilical Region in a Human Embryo 12 cm. in Length


18. Intra-abdominal View of the Umbilical Region in a Human Embryo 9 cm. in  
23. Cross-section of the Umbilical Cord at the Umbilicus in a Human Embryo 12 cm. in Length


Length 18
24. Internal View of the Umbilical Region in a Human Embryo 15 cm. Long


19. Intra-abdominal View of the Umbilical Region in a Human Embryo 10 cm. in
25. A Composite Representation of Abnormal Umbilical Structures, Based on the Work of Keibel, Lowy, and Others


Length 19
26. A Composite Representation of Abnormal Umbilical Structures, Based on the Work of Keibel, Lowy, and Others


20. Intra-abdominal View of the Umbilical Region in a Human Embryo 12 cm. Long . . 19
27. A Composite Representation of Abnormal Umbilical Structures, Based on the Work of Keibel, Lowy, and Others


21. Intra-abdominal View of the Umbilical Region in a Human Embryo 12 cm. in
28. The Umbilical Region in a Fetus about Five Months Old Viewed from the Left


Length 20
29. Side and Posterior Views of the Umbilical Region in a Fetus of Six to Seven Months


22. Intra-abdominal View of the Umbilical Region in a Human Embryo 12 cm. in  
30. Three Diagrams of the Umbilical Ring and Its Significance in the Development of Ventral Hernia


Length 21
31. The Appearance of the Yolk-sac (Umbilical Vesicle) in a Pregnancy, with the Embryo 5.5 cm. Long


23. Cross-section of the Umbilical Cord at the Umbilicus in a Human Embryo 12 cm.
32. The Umbilical Region, the Cord, and the Placenta at Term


in Length 22
33. A Diagrammatic Representation of the Umbilical Region of a Fetus at Term


24. Internal View of the Umbilical Region in a Human Embryo 15 cm. Long 23
34. Normal Umbilicus according to Catteau


25. A Composite Representation of Abnormal Umbilical Structures, Based on the
35. A Type of Umbilical Region in the Adult, Viewed from Within


Work of Keibel, Lowy, and Others 24
36. A Frequent Type of the Umbilical Region in the Adult, Viewed from Within


26. A Composite Representation of Abnormal Umbilical Structures, Based on the
37. The Umbilical Region of an Adult, Viewed from Within


Work of Keibel, Lowy, and Others 24
38. Classic Type of Umbilicus


27. A Composite Representation of Abnormal Umbilical Structures, Based on the  
39. Disposition of the Vascular Cords (Usual Type)


Work of Keibel, Lowy, and Others 24
40. Vascular Cords of the Anastomosing Type, Noted 7 Times in 50 Cases


28. The Umbilical Region in a Fetus about Five Months Old Viewed from the Left . . 25
41. Vascular Cord Type, Noted 5 Times in 50 Cases


29. Side and Posterior Views of the Umbilical Region in a Fetus of Six to Seven
42. Vascular Cords, Noted 5 Times in 50 Cases, Completely Filling the Umbilical Ring


Months 25
43. Vascular Cords, Noted 3 Times in 50 Cases


30. Three Diagrams of the Umbilical Ring and Its Significance in the Development
44. Vascular Cords, Noted in 2 out of 50 Cases


of Ventral Hernia 27
45. Umbilical Fascia. Peritoneum in Place


XV
46. Umbilical Fascia and Umbilical Mesentery


47. Reduplication of the Linea Alba. Peritoneum Removed


48. Atrophy of the Umbilical Fascia, Posterior View


XVI LIST OF ILLUSTRATIONS
49. Formation of a Mesentery. Peritoneum in Place


Fig. Page
50. Mesentery of the Urachus and of the Umbilical Arteries


31. The Appearance of the Yolk-sac (Umbilical Vesicle) in a Pregnancy, with the
51. Adipose Fringes. From a Well-developed Young Woman. Peritoneum in Place


Embryo 5.5 cm. Long 28
52. Adipose Fringes in a Stout Subject. Peritoneum in Place


32. The Umbilical Region, the Cord, and the Placenta at Term 29
53. Peritoneal Diverticula. Peritoneum in Place


33. A Diagrammatic Representation of the Umbilical Region of a Fetus at Term .... 32
54. Peri-umbilical Fossettes. Peritoneum in Place


34. Normal Umbilicus according to Catteau 35
55. Ovarian Pedicle Passing from Uterus out through a Hernial Ring in the Abdominal Wall


35. A Type of Umbilical Region in the Adult, Viewed from Within 44
56. Extra-abdominal Multilocular Fibrocystoma of the Ovary


36. A Frequent Type of the Umbilical Region in the Adult, Viewed from Within .... 44
57. An Extra- abdominal Multilocular Fibrocystoma


37. The Umbilical Region of an Adult, Viewed from Within 45
58. Superficial Lymphatics of the Umbilical Region


38. Classic Type of Umbilicus 47
59. The Deep Umbilical Lymphatics as Seen from the Peritoneal Side


39. Disposition of the Vascular Cords (Usual Type) 48
60. The Umbilical Vessels about the Time of Birth


40. Vascular Cords of the Anastomosing Type, Noted 7 Times in 50 Cases 48
61. The Umbilical Vessels in the Adult


41. Vascular Cord Type, Noted 5 Times in 50 Cases 49
62. 63. Method of Treating the Umbilical Stump at Birth


42. Vascular Cords, Noted 5 Times in 50 Cases, Completely Filling the Umbilical  
64. Nature's Method of Checking Bleeding from the Umbilical Arteries


Ring 49
65. An Umbilical Granulation


43. Vascular Cords, Noted 3 Times in 50 Cases 49
66. The Gradual Atrophy of the Omphalomesenteric Duct


44. Vascular Cords, Noted in 2 out of 50 Cases 50
67. An Umbilical Polyp Connected with Meckel's Diverticulum by a Fibrous Cord


45. Umbilical Fascia. Peritoneum in Place 52
68. An Umbilical Polyp Attached to the Small Bowel by a Fibrous Cord


46. Umbilical Fascia and Umbilical Mesentery 52
69. An Umbilical Polyp on the Prominent Part of an Umbilical Hernia


47. Reduplication of the Linea Alba. Peritoneum Removed 52
70. A Polypoid Outgrowth from the Umbilicus


48. Atrophy of the Umbilical Fascia, Posterior View 53
71. Tubular Glands from the Umbilical Polyp Shown in Fig. 70


49. Formation of a Mesentery. Peritoneum in Place 53
72. A Diverticular Tumor at the Umbilicus


50. Mesentery of the Urachus and of the Umbilical Arteries 53
73. A Glandular Tumor from the Umbilicus


51. Adipose Fringes. From a Well-developed Young Woman. Peritoneum in Place 54
74. A Glandular Growth at the Umbilicus


52. Adipose Fringes in a Stout Subject. Peritoneum in Place 54
75. Section in the Long Axis of a Small Umbilical Growth


53. Peritoneal Diverticula. Peritoneum in Place 55
76. Adenoma of the Umbilicus


54. Peri-umbilical Fossettes. Peritoneum in Place 55
77. Ax Umbilical Polyp Attached to a Meckel's Diverticulum by a Fibrous Cord


55. Ovarian Pedicle Passing from Uterus out through a Hernial Ring in the Ab
78. Ax Umbilical Polyp Attached to a Meckel's Diverticulum by a Fibrous Cord
dominal Wall 57


56. Extra-abdominal Multilocular Fibrocystoma of the Ovary 5S
79. An Umbilical Polyp


57. An Extra- abdominal Multilocular Fibrocystoma 59
80. A Small Intestinal Polyp Almost Fillingthb Umbilical Depression


58. Superficial Lymphatics of the Umbilical Region 64
81. An Umbilical Polyp


59. The Deep Umbilical Lymphatics as Seen from the Peritoneal Side 65
82. Portion of an Intestinal Polyp Partially Filling the Umbilical Depression


60. The Umbilical Vessels about the Time of Birth 72
83. Transverse Section op a Pseudopyloric Congenital Fistula at the Umbilicus


61. The Umbilical Vessels in the Adult 72
84. High-power Picture op a Fistulous Tract at the Umbilicus, Showing Glands Resembling those of the Pylorus


62. 63. Method of Treating the Umbilical Stump at Birth 98
85. An Umbilical Fistula Lined with Mucosa Resembling that of the Stomach


64. Nature's Method of Checking Bleeding from the Umbilical Arteries 107
86. Appearance of the Umbilical Depression in von Rosthorn's Case


65. An Umbilical Granulation 117
87. Gastric Mucosa at the Umbilicus


66. The Gradual Atrophy of the Omphalomesenteric Duct 121
88. Appearance of the Umbilicus After Removal of the Stomach Mucosa Seen in Fig. 87


67. An Umbilical Polyp Connected with Meckel's Diverticulum by a Fibrous Cord . . 121
89. Persistence of the Outer End of the Omphalomesenteric Duct


68. An Umbilical Polyp Attached to the Small Bowel by a Fibrous Cord 121
90. Atrophy of the Inner End of the Omphalomesenteric Duct


69. An Umbilical Polyp on the Prominent Part of an Umbilical Hernia : . . 123
91. A Long Umbilical Polyp as a Remnant of the Omphalomesenteric Duct


70. A Polypoid Outgrowth from the Umbilicus 129
92. Meckel's Diverticulum


71. Tubular Glands from the Umbilical Polyp Shown in Fig. 70 129
93. A Meckel's Diverticulum Attached to the Abdominal Wall at the Umbilicus


72. A Diverticular Tumor at the Umbilicus 132
94. An Abnormally Large Meckel's Diverticulum


73. A Glandular Tumor from the Umbilicus 132
95. A Meckel's Diverticulum with a Lobulated Extremity


74. A Glandular Growth at the Umbilicus 133
96. A Meckel's Diverticulum with Hernial Protrusions from Its Surface


75. Section in the Long Axis of a Small Umbilical Growth 134
97. A Short Meckel's Diverticulum Springing from the Mesenteric Attachment


76. Adenoma of the Umbilicus 135
98. An Accessory Pancreas in the Tip of Meckel's Diverticulum


77. Ax Umbilical Polyp Attached to a Meckel's Diverticulum by a Fibrous Cord. 138
99. A Meckel's Diverticulum Completely Tying off a Loop of Small Bowel


78. Ax Umbilical Polyp Attached to a Meckel's Diverticulum by a Fibrous Cord . . . 138
100. A Diverticulum Tying Off a Loop of Small Bowel


79. An Umbilical Polyp 139
101. Strangulation of a Meckel's Diverticulum Causing Volvulus of the Ileum


80. A Small Intestinal Polyp Almost Fillingthb Umbilical Depression 139
102. Fatal Intestinal Obstruction Due to the Passage of the Bowel through a Hole in the Mesentery of a Meckel's Diverticulum


81. An Umbilical Polyp 140
103. Inversion of a Meckel's Diverticulum into the Lumen of the Bowel


82. Portion of an Intestinal Polyp Partially Filling the Umbilical Depression .... 141
104. A Well-developed Loop of Small Bowel in a Dermoid Cyst of the Ovary


83. Transverse Section op a Pseudopyloric Congenital Fistula at the Umbilicus . . . . 149
105. An Intestinal Cyst


106. An Intestinal Cyst Attached to the Umbilicus by a Pedicle but not Connected with the Bowel


107. Volvulus of Meckel's Diverticulum


LIST OF ILLUSTRATIONS XV11
108. An Intestinal Cyst Developing from Meckel's Diverticulum


Fia. Fage
109. Intestinal Cysts in the Abdominal Cavity


84. High-power Picture op a Fistulous Tract at the Umbilicus, Showing Glands Re
1 10. An Intramesenteric Cyst
sembling those of the Pylorus 150


85. An Umbilical Fistula Lined with Mucosa Resembling that of the Stomach 150
111. A Patent Omphalomesenteric Duct


86. Appearance of the Umbilical Depression in von Rosthorn's Case 152
112. A Patent Omphalomesenteric Duct with a Polypoid Formation at the Umbilicus


87. Gastric Mucosa at the Umbilicus 153
113. A Very Short Omphalomesenteric Duct


88. Appearance of the Umbilicus After Removal of the Stomach Mucosa Seen in
114. A Patent Omphalomesenteric Duct with a Polyp-like Formation at the Umbilicus


Fig. 87 154
1 15. A Patent Omphalomesenteric Duct


89. Persistence of the Outer End of the Omphalomesenteric Duct 156
116. A Patent Omphalomesenteric Duct


90. Atrophy of the Inner End of the Omphalomesenteric Duct 156
117. A Patent Omphalomesenteric Duct


91. A Long Umbilical Polyp as a Remnant of the Omphalomesenteric Duct 156
118. A Patent Omphalomesenteric Duct


92. Meckel's Diverticulum 159
119. A Patent Omphalomesenteric Duct


93. A Meckel's Diverticulum Attached to the Abdominal Wall at the Umbilicus. . 160
120. A Patent Omphalomesenteric Duct


94. An Abnormally Large Meckel's Diverticulum 161
121. A Patent Omphalomesenteric Duct


95. A Meckel's Diverticulum with a Lobulated Extremity 161
122. Part of a Patent Omphalomesenteric Duct


96. A Meckel's Diverticulum with Hernial Protrusions from Its Surface 162
123. Intestinal Mucosa Covering the Cutaneous or Umbilical End of a Patent Omphalomesenteric Duct


97. A Short Meckel's Diverticulum Springing from the Mesenteric Attachment . . 163
124. An Umbilical Polyp and a Fibrous Nodule at the Umbilicus. There was Originally a Patent Omphalomesenteric Duct


98. An Accessory Pancreas in the Tip of Meckel's Diverticulum 163
125. Longitudinal Section through the Entire Center of a Partially Closed Omphalomesenteric Duct


99. A Meckel's Diverticulum Completely Tying off a Loop of Small Bowel 164
126. A Patent Omphalomesenteric Duct


100. A Diverticulum Tying Off a Loop of Small Bowel 165
127. A Patent Omphalomesenteric Duct Opening at the Base of the Umbilical Cord


101. Strangulation of a Meckel's Diverticulum Causing Volvulus of the Ileum. . . . 166
128. A Patent Omphalomesenteric Duct


102. Fatal Intestinal Obstruction Due to the Passage of the Bowel through a
129. A Patent Omphalomesenteric Duct as Seen from the Abdominal Cavity


Hole in the Mesentery of a Meckel's Diverticulum .170
130. Inversion of the Bowel through a Patent Omphalomesenteric Duct Opening on the Side of the Umbilical Cord


103. Inversion of a Meckel's Diverticulum into the Lumen of the Bowel 171
131. A Patent Omphalomesenteric Duct of Large Diameter


104. A Well-developed Loop of Small Bowel in a Dermoid Cyst of the Ovary 175
132. Commencing Prolapsus of Small Bowel through a Patent Omphalomesenteric Duct


105. An Intestinal Cyst 176
133. Partial Prolapsus of the Small Bowel through the Omphalomesenteric Duct


106. An Intestinal Cyst Attached to the Umbilicus by a Pedicle but not Connected
134. Prolapsus of the Small Bowel through the Patent Omphalomesenteric Duct


with the Bowel 176
135. Complete Prolapsus of the Bowel through the Patent Omphalomesenteric Duct


107. Volvulus of Meckel's Diverticulum 177
136. Prolapsus of the Small Bowel through the Patent Omphalomesenteric Duct, and an Umbilical Hernia between the Loops of Prolapsed Bowel


108. An Intestinal Cyst Developing from Meckel's Diverticulum 178
137. Prolapse of the Small Bowel through an Open Omphalomesenteric Duct


109. Intestinal Cysts in the Abdominal Cavity 182
138. Prolapsus of the Bowel through a Patent Omphalomesenteric Duct


1 10. An Intramesenteric Cyst 183
139. Prolapsus of the Bowel through a Patent Omphalomesenteric Duct, with Secondary Complications


111. A Patent Omphalomesenteric Duct 190
140. Prolapsus and Inversion of the Intestine through a Patent Omphalomesenteric Duct


112. A Patent Omphalomesenteric Duct with a Polypoid Formation at the Umbilicus . 190
141. Prolapsus of the Bowel through the Patent Omphalomesenteric Duct  


113. A Very Short Omphalomesenteric Duct 190
142. A Small Cyst of the Umbilicus Due to a Remnant of the Omphalomesenteric Duct


114. A Patent Omphalomesenteric Duct with a Polyp- like Formation at the Umbil
143. Small Cyst of the Abdominal Wall Due to a Remnant of the Omphalomesenteric Duct
icus 190


1 15. A Patent Omphalomesenteric Duct 192
144. A Small Intestinal Cyst Lying between the Peritoneum and the Recti


116. A Patent Omphalomesenteric Duct 193
145. An Omphalomesenteric Duct Originating from the Concave Side of the Bowel and Attached to the Umbilicus by a Fibrous Cord


1 17. A Patent Omphalomesenteric Duct 197
146. A Remnant of an Omphalomesenteric Duct Causing Fatal Intestinal Obstruction


118. A Patent Omphalomesenteric Duct 197
147. A Small Umbilical Concretion


119. A Patent Omphalomesenteric Duct 202
148. Acute Inflammation of the Umbilicus Due to an Accumulation of Sebaceous Material


120. A Patent Omphalomesenteric Duct 205
149. Cholesteatoma from the Umbilicus in Case 1


121. A Patent Omphalomesenteric Duct 206
150. Cholesteatoma from Case 2 


122. Part of a Patent Omphalomesenteric Duct 206
151. A Connective-tissue Projection Really Representing a Small Fibroma in the Floor of the Umbilicus


123. Intestinal Mucosa Covering the Cutaneous or Umbilical End of a Patent Om
152. Enlargement of Fig. 151
phalomesenteric Duct 207


124. An Umbilical Polyp and a Fibrous Nodule at the Umbilicus. There was Origin
153. Subumbilical Phlegmon
ally a Patent Omphalomesenteric Duct 209


125. Longitudinal Section through the Entire Center of a Partially Closed Om
154. The Subumbilical Space
phalomesenteric Duct 209


126. A Patent Omphalomesenteric Duct 211
155. Paget's Disease of the Umbilicus


127. A Patent Omphalomesenteric Duct Opening at the Base of the Umbilical Cord . . 216
156. Paget's Disease of the U/mbilicus


128. A Patent Omphalomesenteric Duct 216
157. Paget's Disease of the Umbilicus


129. A Patent Omphalomesenteric Duct as Seen from the Abdominal Cavity 216
158. Paget's Disease of the Umbilicus


130. Inversion of the Bowel through a Patent Omphalomesenteric Duct Opening on the Side of the Umbilical Cord 219
159. The Appearance in a Case of Paget's Disease of the Umbilicus After Treatment with Radium


131. A Patent Omphalomesenteric Duct of Large Diameter 224
160. Syphilis of the Umbilicus


132. Commencing Prolapsus of Small Bowel through a Patent Omphalomesenteric Duct 224
161. Atrophic Tuberculid Starting at the Umbilicus


133. Partial Prolapsus of the Small Bowel through the Omphalomesenteric Duct . . . 224
162. Leakage from an Abdominal Aneurysm Producing a Temporary Abdominal Tumor; Subsequent Escape of the Blood into the Right Renal Pocket


134. Prolapsus of the Small Bowel through the Patent Omphalomesenteric Duct .... 224
163. The Manner in Which a Periprostatic Abscess may Occasionally Rupture at the Umbilicus


135. Complete Prolapsus of the Bowel through the Patent Omphalomesenteric Duct 225
164. Escape of Pleural Fluid from the Umbilicus


136. Prolapsus of the Small Bowel through the Patent Omphalomesenteric Duct, and an Umbilical Hernia between the Loops of Prolapsed Bowel 225
165. The Opening of a Broad Ligament Abscess at the Umbilicus


137. Prolapse of the Small Bowel through an Open Omphalomesenteric Duct 227
166. Abdominal Pregnancy with Spontaneous Escape of Liquor Amnii from the Umbilicus


138. Prolapsus of the Bowel through a Patent Omphalomesenteric Duct 228
167. Small Papilloma in the Umbilical Depression


139. Prolapsus of the Bowel through a Patent Omphalomesenteric Duct, with Sec
168. A Shall Umbilical Tumor Containing Glands and Stroma Identical with Those of the Uterine Mucosa
ondary Complications 229


140. Prolapsus and Inversion of the Intestine through a Patent Omphalomesenteric Duct 230
169. Glands from a Small Umbilical Tumor


141. Prolapsus of the Bowel through the Patent Omphalomesenteric Duct 232
170. Typical Uterine Mucosa in a Small Umbilical Tumor. An Enlargement of Area B in Fig. 168


142. A Small Cyst of the Umbilicus Due to a Remnant of the Omphalomesenteric Duct 238
171. Glands in a Small Umbilical Tumor


143. Small Cyst of the Abdominal Wall Due to a Remnant of the Omphalomesenteric Duct 238
172. Dilated Glands in a Small Umbilical Tumor


144. A Small Intestinal Cyst Lying between the Peritoneum and the Recti 240
173. Dichotomous Branching of Glands in a Small Umbilical Tumor


145. An Omphalomesenteric Duct Originating from the Concave Side of the Bowel and Attached to the Umbilicus by a Fibrous Cord 243
174. Uterine Glands in an Umbilical Tumor


146. A Remnant of an Omphalomesenteric Duct Causing Fatal Intestinal Obstruction 245
175. Gland Hypertrophy in a Small Umbilical Tumor


147. A Small Umbilical Concretion 249
176. A Tumor of the Umbilicus Composed Partly of Hypertrophic Sweat-glands


148. Acute Inflammation of the Umbilicus Due to an Accumulation of Sebaceous Material 249
177. Uterine Mucosa in an Umbilical Tumor


149. Cholesteatoma from the Umbilicus in Case 1 251
178. A Small Umbilical Tumor Containing Numerous Glands


150. Cholesteatoma from Case 2 251
179. Glands in a Small Umbilical Tumor


151. A Connective-tissue Projection Really Representing a Small Fibroma in the Floor of the Umbilicus 252
180. An Adenomyoma in the Abdominal Wall Near the Anterior Iliac Spine


152. Enlargement of Fig. 151 252
181. A Small Umbilical Tumor Containing Glands Similar to Those of the Body of the Uterus


153. Subumbilical Phlegmon 262
182. Adenomyoma of the Umbilicus


154. The Subumbilical Space 264
183. A Group of Sweat-glands in an Umbilical Tumor


155. Paget's Disease of the Umbilicus 270
184. Appearance of the Carcinomatous Umbilicus After Removal


156. Paget's Disease of the U/mbilicus 270
185. Carcinoma of the Umbilicus Secondary to Carcinoma of the Ovaries


157. Paget's Disease of the Umbilicus 271
186. A Malignant Growth of the Umbilicus, Apparently a Carcinoma Secondary to Some Abdominal Growth


158. Paget's Disease of the Umbilicus 274
187. Adenocarcinoma of the Umbilicus Secondary to an Intra-abdominal Growth


159. The Appearance in a Case of Paget's Disease of the Umbilicus After Treatment with Radium 275
188. Adenocarcinoma of the Umbilicus


160. Syphilis of the Umbilicus 284
189. A Section Showing Carcinoma of the Right Inguinal Glands


161. Atrophic Tuberculid Starting at the Umbilicus 286
190. Secondary Carcinoma of the Umbilicus


162. Leakage from an Abdominal Aneurysm Producing a Temporary Abdominal Tumor; Subsequent Escape of the Blood into the Right Renal Pocket 288
191. Telangiectatic Myxosarcoma of the Umbilicus


163. The Manner in Which a Periprostatic Abscess may Occasionally Rupture at the Umbilicus 289
192. Appearance of the Umbilicus After Removal of the Tumor Shown in Fig. 191


164. Escape of Pleural Fluid from the Umbilicus 289
193. Myxosarcoma of the Umbilicus  


165. The Opening of a Broad Ligament Abscess at the Umbilicus 290
194. Telangiectatic Myxosarcoma Projecting from the Right Side of the Umbilicus


166. Abdominal Pregnancy with Spontaneous Escape of Liquor Amnii from the Umbilicus 348
195. A Telangiectatic Myxosarcoma


167. Small Papilloma in the Umbilical Depression 365
196. A Case of Congenital Umbilical Hernia


168. A Shall Umbilical Tumor Containing Glands and Stroma Identical with Those of the Uterine Mucosa 376
197. An Amniotic Hernia


169. Glands from a Small U\iisiLirALTuMOR 377
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


170. Typical Uterine Mucosa in a Small Umbilical Tumor. An Enlargement of Area B in Fig. 168 378
199. A Serous Umbilical Hernia


171. Glands in a Small Umbilical Tumor 379
200. Freeing the Umbilical Hernial Sac from the Abdomen


172. Dilated Glands in a Small Umbilical Tumor 380
201. Closure of the Hernial Opening at the Umbilicus


173. Dichotomous Branching of Glands in a Small Umbilical Tumor 381
202. Closure of the Hernial Opening at the Umbilicus


174. Uterine Glands in an Umbilical Tumor 381
203. An Umbilical Hernia Associated with Marked Prolapsus of the Abdominal Wall


175. Gland Hypertrophy in a Small Umbilical Tumor 382
204. An Umbilical Hernia and a Markedly Pendulous Abdomen in a Patient Weighing 464 Pounds


176. A Tumor of the Umbilicus Composed Partly of Hypertrophic Sweat-glands 383
205. The Abdominal Scar After the Removal of a Very Large Area of Fat


177. Uterine Mucosa in an Umbilical Tumor 384
206. An Umbilical Cyst


178. A Small Umbilical Tumor Containing Numerous Glands 388
207. Exstrophy of the Bladder Opening at or Near the Umbilicus


179. Glands in a Small Umbilical Tumor 389
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


180. An Adenomyoma in the Abdominal Wall Near the Anterior Iliac Spine 394
209. Exstrophy of the Bladder


181. A Small Umbilical Tumor Containing Glands Similar to Those of the Body of the Uterus 396
210. Escape of Urine from the Umbilicus When the Inner Urethral Orifice Is Blocked by a Membrane


182. Adenomyoma of the Umbilicus 397
211. A Patent Urachus with a Mushroom-like Projection at the Umbilicus


183. A Group of Sweat-glands in an Umbilical Tumor 398
212. A Patent Urachus with a Penile Projection at the Umbilicus


184. Appearance of the Carcinomatous Umbilicus After Removal 424
213. The Appearance of the Umbilicus in a Case in Which both a Patent Omphalomesenteric Duct and a Patent Urachus Existed


185. Carcinoma of the Umbilicus Secondary to Carcinoma of the Ovaries 432
214. Cross-section of the Patent Omphalomesenteric Duct and of the Patent Urachus in the Same Child


186. A Malignant Growth of the Umbilicus, Apparently a Carcinoma Secondary to Some Abdominal Growth 439
215. A Picture of the Child Three Weeks After Removal of a Patent Omphalomesenteric Duct and a Patulous Urachus


187. Adenocarcinoma of the Umbilicus Secondary to an Intra-abdominal Growth .... 440
216. A Patent Urachus


188. Adenocarcinoma of the Umbilicus 441
217. A Urachus Open from Bladder to Umbilicus


189. A Section Showing Carcinoma of the Right Inguinal Glands 442
218. An Open Urachus


190. Secondary Carcinoma of the Umbilicus 443
219. Escape of Urine from the Umbilicus Due to a Patent Urachus


191. Telangiectatic Myxosarcoma of the Umbilicus 450
220. A Patent Urachus with a Penile Projection at the Umbilicus


192. Appearance of the Umbilicus After Removal of the Tumor Shown in Fig. 191. . 450
221. A Ring-shaped Vesical Calculus with a Fine Hair in Its Axis


193. Myxosarcoma of the Umbilicus 451
222. A Partially Patent Urachus


194. Telangiectatic Myxosarcoma Projecting from the Right Side of the Umbilicus . . 452
223. A Patent Urachus


195. A Telangiectatic Myxosarcoma 452
224. A Portion of a Urachus Seven Times Enlarged, with Numerous Large and Small Dilatations


196. A Case of Congenital Umbilical Hernia 460
225. Portion of a Urachus Ten Times Enlarged


197. An Amniotic Hernia 462
226. Cysts of the Urachus Arranged Like a String of Pearls


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
227. Spindle-Shaped Dilatations of the Urachus


199. A Serous Umbilical Hernia 469
228. A Small Cyst of the Urachus


200. Freeing the Umbilical Hernial Sac from the Abdomen 472
229. A Patent Urachus


201. Closure of the Hernial Opening at the Umbilicus 473
230. A Multilocular Cyst of the Urachus


202. Closure of the Hernial Opening at the Umbilicus 474
231. Section of a Patent Urachus


203. An Umbilical Hernia Associated with Marked Prolapsus of the Abdominal Wall 475
232. Transverse Section of a Patent Urachus


204. An Umbilical Hernia and a Markedly Pendulous Abdomen in a Patient Weighing 464 Pounds 476
233. A Small Cyst of the Urachus


205. The Abdominal Scar After the Removal of a Very Large Area of Fat 477
234. A Diffuse Neuroma of the Bladder


206. An Umbilical Cyst 478
235. Cut Surface of the Bladder Showing a Diffuse Neuroma of Its Walls


207. Exstrophy of the Bladder Opening at or Near the Umbilicus 482
236. A Diffuse Neuroma Forming a Mantle Around the Cavity of the Bladder


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
237. Diagram Showing the Arrested Development of the Genital Tract and the Relation of the Malformed Parts to the Cyst of the Urachus
 
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  
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
239. The Abdominal Contour in a Case of Very Large Urachal Cyst


240. A Urachal Cyst Turned Inside Out and Showing Papillary Masses, Particularly in the Lower Part of the Picture 559  
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
241. Infected Urachal Remains


242. An Infected Urachus Opening between the Umbilicus and Bladder 570
242. An Infected Urachus Opening between the Umbilicus and Bladder


243. Urachal Cyst 576
243. Urachal Cyst


244. A Dilated Urachus Communicating with the Bladder 579
244. A Dilated Urachus Communicating with the Bladder


245. Large Accumulation of Urine in a Partially Patent Urachus 579
245. Large Accumulation of Urine in a Partially Patent Urachus


246. An Infected Urachus Opening at the Umbilicus 580
246. An Infected Urachus Opening at the Umbilicus


247. A Patent Urachus Dilated in Its Middle Portion 580
247. A Patent Urachus Dilated in Its Middle Portion


248. Accumulation of a Large Quantity of Urine in a Urachal Pouch 581
248. Accumulation of a Large Quantity of Urine in a Urachal Pouch


249. Fetal Bones Removed from an Old Extra-uterine Pregnancy Sac 584
249. Fetal Bones Removed from an Old Extra-uterine Pregnancy Sac


250. A Phosphatic Deposit on the End of a Long Bone 585
250. A Phosphatic Deposit on the End of a Long Bone


251. A Dilated Urachus Communicating with the Bladder 598
251. A Dilated Urachus Communicating with the Bladder


252. Urachal Cyst 599
252. Urachal Cyst


253. Urachal Cyst 603
253. Urachal Cyst


254. Urachal Cyst 603
254. Urachal Cyst


255. A Patent Urachus Containing a Vesical Calculus 625
255. A Patent Urachus Containing a Vesical Calculus


256. Carcinoma of the Patent Urachus 632
256. Carcinoma of the Patent Urachus


257. A Multilocular and Malignant Cyst of the Urachus 637
257. A Multilocular and Malignant Cyst of the Urachus


258. Giant-cells in the Wall of an Adenocarcinomatous Cyst of the Urachus 638
258. Giant-cells in the Wall of an Adenocarcinomatous Cyst of the Urachus


259. Giant-cells in the Wall of an Adenocarcinoma of the Urachus 639
259. Giant-cells in the Wall of an Adenocarcinoma of the Urachus


260. Giant-cells in the Wall of an Adenocarcinomatous Cyst of the Urachus. . .640-641
260. Giant-cells in the Wall of an Adenocarcinomatous Cyst of the Urachus


261. Adenocarcinoma of the Urachus 642
261. Adenocarcinoma of the Urachus


262. A Papillary-like Area i.\ an Adkxocarcinomatous Cystofthe Urachus 643
262. A Papillary-like Area in an Adkxocarcinomatous Cystofthe Urachus  


263. Metastasis from Adenocarcinoma of the Urachus 644
263. Metastasis from Adenocarcinoma of the Urachus


264. An Umbilical Cyst 645
264. An Umbilical Cyst


265. \\ aj.i of an Umbilical Cyst 645
265. \\ aj.i of an Umbilical Cyst


266. Giant-cells in the Wall of an Umbilical Cyst 646
266. Giant-cells in the Wall of an Umbilical Cyst


267. Tuberculosis of the Urachus 652
267. Tuberculosis of the Urachus
 
268. An Area Suggesting a Tubercle 653
 
269. A Tubercle from Dr. Eastman's Case of Tuberculosis of the Urachus 654


268. An Area Suggesting a Tubercle


269. A Tubercle from Dr. Eastman's Case of Tuberculosis of the Urachus


==List of Plates==
==List of Plates==
[[Book - Umbilicus (1916) Figures#List of Plates|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
==Chapter XXXVIII. Bleeding from the Urachus into the Bladder==
The literature on this subject is a negligible quantity. W. Ramsay Smith *
reports a case which, although somewhat obscure, may be mentioned here.
The patient, a female infant, was born August 3d. The labor was short, and
the child brought away with forceps. The cord appeared to be normal. On the
second night, August 5th, a large quantity of bright-red blood was noticed on the
infant's binder. It appeared on that night only, and the nurse noticed that it was
coming not from the cord,- but from the umbilicus at the side of the cord. Two
days later (August 7th) the child had an attack of diarrhea, and there was a good
deal of blood in the stools, and it was noticed that this blood was coming from the
urethra. On August 8th the bleeding was very severe, there being over two teaspoonfuls at a time. The blood always appeared when the bowels moved, but it
came from the urethra. The diarrhea ceased, and the bleeding stopped on August
9th. Smith thought that the bleeding took place from the hypogastrics, and
escaped to the bladder along the urachus. Ballantyne felt somewhat reluctant
to accept this explanation, but said that, under the circumstances, it was difficult
to suggest any that was more satisfactory.
A few years ago, while discussing diseases of the umbilical region with Dr.
Edward Reynolds, of Boston, he mentioned the fact that on several occasions he
had noted bleeding from the urachus into the bladder. Later I wrote asking him
kindly to furnish me with the data he had bearing on the subject. His reply was as
follows :
"With regard to my recent hematuric case, the patient was a physician about
thirty-five years old, from whom I removed the appendix about two years ago.
She came to me on the seventh of February, saying that, after very hard and long
automobiling over rough country roads a few days before, she had been seized by
a sudden urgent desire to urinate, and had passed a quantity of bloody urine.
Since then urination had been normal, but the urine was slightly blood-stained.
She informed me that she had noticed that the first part of the urine was clear and
that the blood came with the last few drops. When I first looked into her bladder
the small amount of urine was clear (she had just emptied it). I inspected the
trigonum and fundus of a normal bladder carefully in the knee-chest position, and,
on turning the point of the cystoscope forward, found that in the interval the urine
had become distinctly pink. I then emptied the bladder thoroughly with the
evacuator, and saw a small stream of blood flowing from the orifice of the urachus.
The patient has written me since that the hematuria stopped within forty-eight
hours after her visit to me, and that there was no recurrence. I told her that I
thought there was no other treatment than the removal of the urachus; that I
should not advise that unless the symptoms were persistent; that I should advise
* Smith, W. Ramsay: Obstet. Trans., Edinburgh, 1892-93, xviii, 53.
647
648 THE UMBILICUS AND ITS DISEASES.
it if the hematuria were recurrent. I asked her to keep me informed of her progress, and I think that she will do so.
''This is not my first case of the kind. A good many years ago, when I was
doing a large out-patient clinic and making a great many cystoscopic examinations,
I saw a number of cases, I should guess from half a dozen to a dozen, in which minor
vesical symptoms seemed to be associated with a reddened, eroded condition of the
vesical mucous membrane immediately about a small orifice in the upper and anterior part of the bladder, which, after some study, I grew to consider as the orifice
of a patent urachus, and which, on close inspection, I could recognize in a considerable proportion of bladders in which it was not making trouble. I believe that this
slight anomaly is very common, and that it is a not unimportant lurking-place for
bacteria in infected bladders. In at least two cases in these old days I saw bleeding
from this orifice; I think in more than that number, but the conditions of the
clinic made careful record keeping very difficult. I should say that the hematuria
was transient but recurrent. I do not know the ultimate outcome. The patients
in that clinic were all of a class which it is difficult to follow up afterward."
Dr. Reynolds' observation clearly demonstrates that in some cases blood does
escape from the persistent urachus into the bladder. His suggestion that the
urachal opening is probably the lurking-place of bladder infections is fully borne
out by the cystitis frequently noted where a partially patent urachus exists.
CHAPTER XXXIX.
TUBERCULOSIS OF THE PATENT URACHUS.
I have been able to find only two cases of this character in the literature. The
first case was recorded by Briddon and Eliot, the second by Eastman.
Dr. Thacher, who made the pathologic report on the extirpated urachus in
Briddon and Eliot's case, after giving a very careful and guarded description,
decided that the condition was probably tuberculous. Dr. Eastman sent us his
specimen and we have been able to demonstrate tubercle bacilli in the urachus.
"Tubercular Degeneration of the Patent Urachus
in the Adult.* — R. M., aged nineteen, Roumanian; married. Admitted July
17, 1899. No tubercular family or personal history. The patient has always been
well until five weeks ago, when she began to have slight pain, with heat, redness',
and swelling in the region of the umbilicus, the navel having previously been always
normal in appearance. The symptoms increased for two weeks, at the end of
which time there was a small red tumor, the size of a pea, in the region of the
umbilicus. During this time the patient suffered intensely from severe, sharp
pain, almost constantly present, in the hypogastric region, with well-marked
vesical tenesmus, increased frequency of micturition (often voiding urine every
hour), and occasionally a small amount of blood in the urine. At the end of the
two weeks the swelling opened spontaneously, discharging some cloudy fluid with
a uriniferous and foul odor, the pain and swelling soon subsiding. About four
days after the discharge of fluid at the umbilicus, she ceased to pass water normally,
and since then she has had a constant discharge of cloudy fluid of a uriniferous
odor, at times slightly blood-stained, through the opening at the umbilicus. She
has lost considerable flesh and strength during the period of five weeks.
"Physical Examination. — The patient is markedly anemic and is apathetic.
The facies is flushed; the tongue is moist and not heavily coated. The superficial
glands are not enlarged. In the heart there is a hemic murmur over the pulmonic
area, systolic in time. Percussion of the lungs is normal, but the breathing is
rather poor. The abdomen is soft, retracted, and no masses can be felt. At the
inferior portion of the umbilicus is a small sinus with everted and ulcerated edges,
which discharges a seropurulent fluid of uriniferous odor. A probe introduced into
the sinus goes downward and extends evidently as far as the bladder. The bladder
does not percuss high, but there is some tenderness on pressure over the suprapubic
region. Urine analysis at the time of admission showed very turbid and cloudy
urine, with specific gravity of 1014, 15 per cent of sediment, reaction strongly
alkaline, and odor foul and ammoniacal. There was 10 per cent of albumin, no
blood, a large amount of mucus, much pus, and many vesical cells, with many
crystals of triple phosphate. No casts were found. She was placed upon bladder
irrigations twice daily, with warm 0.5 per cent, boric-acid solution, and salol (gr. v)
* Briddon, C. K., and Eliot, E.: Med. and Surg. Reports, Presbyterian Hospital, New York,
January, 1900, iv, 30.
649
650 THE UMBILICUS AND ITS DISEASES.
three times a day. There was no improvement under this treatment, either in the
character of the urine or in the patient's general condition, except that she had
slightly less pain. At the end of a week the bladder irrigation was changed to
carbolic acid, in strength of 1 : 120. This also seemed to have no effect upon the
urine, frequent examinations up to the time of operation giving about the same
result. As at the first analysis, the specific gravity never rose above 1014; the
urine always remained alkaline and was full of pus and mucus. The temperature
course was irregular, varying between 99.5° F. and 102° F., and did not seem to be
influenced in any way by the bladder washing. During a period of several days of
fairly constant low temperature the patient gave a moderately characteristic
tuberculin reaction. The average daily amount of urine voided by the urachus
varied from 15 to 20 ounces. At intervals of several days she voided a few drams
or an ounce of urine per urethram.
" Owing to the obstinate, unyielding cystitis, it was thought advisable to do
a suprapubic cystotomy for purposes of drainage.
" Operation (August 25th) . — Dr. Eliot. Nitrous oxid and ether; asepsis; dorsal position. A catheter was introduced through the urethra into the bladder and
urine was withdrawn. Four ounces of warm 1 per cent boric-acid solution were
then gently thrown into the bladder by a fountain syringe, six ounces of water,
injected into a Barnes dilator, having been previously inserted into the rectum.
A 23^-inch median incision was then made above the pubis and deepened down to
the space of Retzius. The soft cellular tissue here being pushed aside and the
bladder presenting, two silk sutures were passed in a longitudinal fashion through
its wall, separated by a distance of one inch, these sutures being placed for purposes
of traction. The bladder was then opened between the silk sutures, the boricacid fluid pouring out into the wound. The incision in the bladder-wall being
subsequently enlarged upward, disclosed the urachus opening into the fundus of
the bladder. There were several small areas of ulceration on the posterior wall of
the bladder, and parts of the ulcers, together with a portion of the urachus, were
secured for microscopic examination. The ulcerated areas upon the bladder-wall
were cauterized with a thermocautery. The lumen of the urachus was packed
with a strip of iodoform gauze, the cavity of the bladder being drained through the
suprapubic wound in the usual way by means of a tube.
"Report by J. S. Thacher, Pathologist.- — A. Minute fragment of tissue from
urachus. Microscopic examination shows a mass of smooth muscle and connective tissue. The muscle-cells vary somewhat in size and shape, and are irregular
in arrangement.
"B. Minute fragments from base of bladder. The epithelium is partly destroyed, and the tissues are much inflamed. The inflammation appears to be of
some standing.
"The bladder was drained very satisfactorily for ten days by the siphon drainage apparatus, the suprapubic wound remaining comparatively clean and dry. The
patient's temperature was increased for six days following the operation. Recovery
was uneventful. Bladder irrigation with carbolic acid, 1:40, was employed, when
the drainage apparatus was dispensed with, the urine clearing up slightly and the
pain becoming much less severe. She seemed to improve in general health to a
moderate degree. Urine was not voided normally after the suprapubic operation
had been performed.
TUBERCULOSIS OF THE PATENT URACHUS. 651
"September 25th: Urine, for about one week, has had much less pus and mucus in it, and hypogastric pain has been much less severe. It was then decided
to attempt an extirpation of the patent urachus, leaving the suprapubic wound
unmolested.
"Operation (September 27th). — Dr. Briddon; nitrous oxid and ether; asepsis;
dorsal position. A median incision was made from the umbilicus down to the
suprapubic wound of the previous operation, exposing the linea alba, which was
split up in the line of the incision, exposing granulation tissue forming the wall
of the patent urachus. By blunt dissection this tissue was then dissected free
from the underlying thickened peritoneum, during which process the urachus was
opened longitudinally through a portion of its extent. The walls of the urachus
were nearly a quarter of an inch thick, and their diameter was about half an inch.
At its point of junction with the bladder it was cut transversely and removed, the
general cavity of the peritoneum not being opened. A clean surface was thus left,
whose floor was formed by the thickened peritoneum, and its sides by the divided
portion of the linea alba. This tract was closed by eight interrupted chromic
catgut sutures, passing from one side to the other through the skin and linea
alba, thus approximating the raw edges of the tract. A sterile dressing was
placed on the sutured wound, a rubber drainage-tube and iodoform gauze being
left in the suprapubic wound.
" Report of J. S. Thacher, Pathologist. — Extirpation of patent urachus. Microscopic examination : Granulation tissue ; spots of marked infiltration by leukocytes; several small necrotic spots; many giant-cells; some tissue resembling
tubercle tissue — probably tubercular.
" Recovery from the operation was uneventful. The bladder was drained satisfactorily for ten days, the wound for urachus extirpation healing by primary union
without complication. Her general health rapidly improved, and she had gradually
less hypogastric pain and discomfort. For a few weeks the patient voided no urine
normally, all being discharged through the suprapubic wound. Since then she
has passed almost every day one or more ounces of urine per urethram, in gradually
increasing quantity. Her general condition is very much improved, the suprapubic
wound is steadily closing, and urinary analysis now gives but 3 per cent, of albumin,
with much less pus and mucus.
"Repeated examination of urine failed to discover any tubercle bacilli, and
careful physical examination by G. A. Tuttle failed to detect any evidence of
pulmonary or other visceral tuberculosis.
"Examination conducted by Dr. Tuttle, in the pathologic laboratory, of the
small ulcers which were excised from the wall of the bladder at the time of the first
operation, failed to yield positive indications of tuberculosis; conclusive evidence
at last was furnished by the examination by Dr. Thacher of the urachus itself,
removed by Dr. Briddon at the time of the second operation. Inferences are
always uncertain, and although the statement that the tubercular process originated
in the patent remnant of the duct itself is not entirely justifiable, nevertheless, the
fact remains that examination of its wall after removal showed much more abundant
evidence of tuberculosis than did the portion of the bladder-wall removed earlier
by suprapubic cystotomy."
In the case under discussion the removal of the urachus was accomplished without opening the general peritoneal cavity.
652
THE UMBILICUS AND ITS DISEASES.
I was particularly anxious to see a section from this case, and accordingly wrote
Dr. Thacher. In his reply, dated New York, April 8, 1914, he gave me the results
of his examination, but said the original slide could not be located.
Tuberculosis of the Urachus.* ■ — Dr. Eastman has just recorded
a very interesting case of tuberculosis of the urachus in a girl aged nineteen.
"Family History. — Father died of cancer of the stomach at the age of fifty-one;
one brother died during infancy of meningitis; history otherwise negative, particularly as relates to tuberculosis or neoplasms.
Fig. 267. — Tuberculosis of the Urachus.
This is a low-power photomicrograph from Dr. J. R. Eastman's case. At a is an area of caseation surrounded by
tissue closely resembling that found in tuberculosis. The outer walls are composed of non-striped muscle and fibrous
tissue. Scattered throughout this tissue are localized foci more or less characteristic of those noted in tuberculosis.
The areas b and c are very suggestive of tubercles.
The high-power picture of the area b is shown in Fig. 268; that of the area c, in Fig. 269.
"Personal History. — Typhoid at seventeen with good recovery; history otherwise negative; patient married two years and four months; one pregnancy, child
living and well; at no time night-sweats or protracted cough; no characteristic
temperature history; no other evidences of tuberculosis.
"Menstrual History. — Menstruation began at twelve; regular; duration five
days and free; no change in type since marriage or labor.
"Urination. — No increase in frequency, no nocturnal urination. Three diurnal
urinations; never any blood or burning or stinging.
"History of illness for which patient entered hospital. — This trouble began ten
* Eastman, Joseph Rilus: Amer. Jour, of Obstetrics, 1915, lxxii, 640.
TUBERCULOSIS OF THE PATENT URACHUS.
653
months before entrance. While working in the garden, pain was felt at a point in
the mid-line of the abdomen between the symphysis pubis and the umbilicus. At
this time patient noticed a lump at the point designated, the size of a small apple.
There was not much actual pain nor soreness. The mass did not increase in size
but the tenderness remained. This condition persisted for three months when a
pin-point opening appeared in the mid-line of the anterior abdominal wall, half-way
between the symphysis pubis and the umbilicus. This opening discharged a clear
watery fluid for about a week. Then a serous crust closed the opening. The
opening again discharged after about a week, continuing to do so for one week and
again the crust was formed. This process of closing and opening continued for
several months. The size of the tumor did not change. The tenderness still persisted. There had never been any disturbance of the bladder, intestines or uterus.
a
•1
b
x
d c
Fig. 26S. — An Area Suggesting a Tubercle.
This picture is a high-power magnification of the area b in Fig. 267. Its confines are indicated by x and x. Scattered throughout this area are spindle cells and round cells. At a and b are giant-cells. At c the cells are so arranged
as to suggest a small gland. At d is a large cell bearing a strong resemblance to a squamous cell.
The discharge had always been free from odor. She is positive that the discharge
never had a urinous odor.
"Status Prsesens. — The patient's general health was unimpaired. Urinalysis
and physical examination of the chest and abdomen were negative. There were
no evidences of pulmonary tuberculosis nor of tuberculosis elsewhere. Through
the discharging sinus below the umbilicus a small sound could be passed downward behind the symphysis pubis.
"Operation. — The fistulous tract, upon being dissected free, was found to pass
downward from the discharging orifice, coursing in front of the peritoneum, crossing
the space of Retzius and terminating in a thin cord attached to the anterior bladder
wall in the median line and near to the vesico-urethral junction. Upon being split
open the definite tube-like structure was found to be thin-walled, showing no evidence of inflammation or other pathological condition except near the external
discharging orifice, where an ulcerated mass about 2 cm. in width was situate upon
the dorsal wall of the tube.
"Cystoscopic Examination. — Bladder distended with 8 ounces of water for
654 THE UMBILICUS AND ITS DISEASES.
examination: vesical sphincter normal in outline; trigone normal; both ureteral
openings and the mucosa surrounding them were normal as to contractility and
rhythm. There were no ulcers, tubercles, or any other abnormalities upon the floor
of the bladder. The vesical roof was examined carefully and this portion of the
bladder was found to be absolutely devoid of any ulcer, tubercles, opening, or any
other abnormality of the vesical mucous membrane; and there was not the slightest
hint of any communication with the patent urachus.
"•Chemical and Microscopic Urinalysis. — After operation as before the urine
was normal.
••Clinical Course since Operation. — "Wound closed slowly; there have been no
Fig. 269. — A Tubercle from Dr. Eastman's Case of Tuberculosis of the Urachus.
This L= a high-power picture made by Mr. H. Schapiro from Fig. 267 at c.
The tubercle is oval in form and is fairly well differentiated from the surrounding stroma. The cells of the tubercle
are spindle-shaped, oval, round, or irregular. In the lower part of the tubercle is a large giant cell containing a large
number of nuclei arranged chiefly in its center. The grouping of the nuclei in this giant cell resembles to some extent
that usually found in foreign-body giant cells, but the picture as a whole is strongly suggestive of tuberculosis.
symptoms of any kind relating to the genitourinary organs; there is no evidence of
return of the disease."


I wrote Dr. Eastman asking if he could send me sections of the urachus. This
# [[:File:Cullen1916 plate01.jpg|Drawings of Normal Umbilici]]
he promptly did. An examination of them shows the following:
# [[:File:Cullen1916 plate02.jpg|Drawings of Normal Umbilici]]
# [[:File:Cullen1916 plate03.jpg|Drawings of Normal Umbilici]]
# [[:File:Cullen1916 plate04.jpg|Drawings of Normal Umbilici]]
# [[:File:Cullen1916 plate05.jpg|Cancer of the Umbilicus Apparently Secondary to a Tumor of the Ovary]]
# [[:File:Cullen1916 plate06.jpg|Umbilical Hernia]]
# [[:File:Cullen1916 plate07.jpg|Exstrophy of the Bladder]]


The central portion of the specimen consists of granular tissue containing a few
cells. It looks very much like caseous tissue (Fig. 267a). External to this is a
tissue made up of young connective-tissue cells and fairly large round cells with
small round nuclei, and beneath this a zone containing a few giant cells. The
outer wall apparently consists of non-striped muscle and connective tissue infiltrated with small round cells. In this are round or oval areas containing aggregations of epithelioid cells with giant cells scattered here and there throughout them
[Figs. 208 and 269;. External to this zone is the surrounding adipose tissue. The
entire picture strongly indicates tuberculosis of the urachus.


Dr. Benjamin O. McCleary and Dr. George L. Stickney have each independently demonstrated tubercle bacilli in the sections; consequently this is a definite
{{Cullen1916 footer}}
of tuberculosis of the urachus.
[[Category:Draft]]

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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

Cullen1916 titlepage.jpg

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



  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

Figures

1. Sagittal Section Showing a Very Early Stage in the Formation of the Umbilicus and allantois

2. A More Advanced Stage in the Formation of the Umbilical Region

3. A Composite Picture Showing the Formation of the Umbilicus in an Embryo

4. A Diagrammatic Representation of a Human Embryo, about 3.5 mm. Long, Showing the Effect of the Expanding Amnion upon the Yolk-sac and Body-stalk

5. Sagittal View of a Human Embryo 5 mm. in Length

6. Anterior View and Transverse Section of a Human Embryo 7 mm. Long, Showing the Umbilical Region

7. Sagittal Section of the Umbilical Region in an Embryo 7 mm. in Length

8. Sagittal View of the Umbilical Region of a Human Embryo 10 mm. in Length

9. Graphic Reconstruction of the Umbilical Cord of a Human Embryo 12.5 mm. in Length

10. Anterior View of the Umbilical Cord of a Human Embryo 18 mm. in Length

11. Sagittal Section of the Umbilical Region in a Human Embryo 23 mm. in Length

12. A Graphic Reconstruction of the Umbilical Region of a Human Embryo 3 cm. Long

13. Sagittal Section of the Umbilical Region in a Human Embryo 4.5 cm. in Length

14. A Graphic Reconstruction of the Umbilical Region of a Human Embryo 4.5 cm in Length as Viewed from within the Abdomen

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. Intra-abdominal View of the Umbilical Region in a Human Embryo 7.5 cm. Long

18. Intra-abdominal View of the Umbilical Region in a Human Embryo 9 cm. in Length

19. Intra-abdominal View of the Umbilical Region in a Human Embryo 10 cm. in Length

20. Intra-abdominal View of the Umbilical Region in a Human Embryo 12 cm. Long

21. Intra-abdominal View of the Umbilical Region in a Human Embryo 12 cm. in Length

22. Intra-abdominal View of the Umbilical Region in a Human Embryo 12 cm. in Length

23. Cross-section of the Umbilical Cord at the Umbilicus in a Human Embryo 12 cm. in Length

24. Internal View of the Umbilical Region in a Human Embryo 15 cm. Long

25. A Composite Representation of Abnormal Umbilical Structures, Based on the Work of Keibel, Lowy, and Others

26. A Composite Representation of Abnormal Umbilical Structures, Based on the Work of Keibel, Lowy, and Others

27. A Composite Representation of Abnormal Umbilical Structures, Based on the Work of Keibel, Lowy, and Others

28. The Umbilical Region in a Fetus about Five Months Old Viewed from the Left

29. Side and Posterior Views of the Umbilical Region in a Fetus of Six to Seven Months

30. Three Diagrams of the Umbilical Ring and Its Significance in the Development of Ventral Hernia

31. The Appearance of the Yolk-sac (Umbilical Vesicle) in a Pregnancy, with the Embryo 5.5 cm. Long

32. The Umbilical Region, the Cord, and the Placenta at Term

33. A Diagrammatic Representation of the Umbilical Region of a Fetus at Term

34. Normal Umbilicus according to Catteau

35. A Type of Umbilical Region in the Adult, Viewed from Within

36. A Frequent Type of the Umbilical Region in the Adult, Viewed from Within

37. The Umbilical Region of an Adult, Viewed from Within

38. Classic Type of Umbilicus

39. Disposition of the Vascular Cords (Usual Type)

40. Vascular Cords of the Anastomosing Type, Noted 7 Times in 50 Cases

41. Vascular Cord Type, Noted 5 Times in 50 Cases

42. Vascular Cords, Noted 5 Times in 50 Cases, Completely Filling the Umbilical Ring

43. Vascular Cords, Noted 3 Times in 50 Cases

44. Vascular Cords, Noted in 2 out of 50 Cases

45. Umbilical Fascia. Peritoneum in Place

46. Umbilical Fascia and Umbilical Mesentery

47. Reduplication of the Linea Alba. Peritoneum Removed

48. Atrophy of the Umbilical Fascia, Posterior View

49. Formation of a Mesentery. Peritoneum in Place

50. Mesentery of the Urachus and of the Umbilical Arteries

51. Adipose Fringes. From a Well-developed Young Woman. Peritoneum in Place

52. Adipose Fringes in a Stout Subject. Peritoneum in Place

53. Peritoneal Diverticula. Peritoneum in Place

54. Peri-umbilical Fossettes. Peritoneum in Place

55. Ovarian Pedicle Passing from Uterus out through a Hernial Ring in the Abdominal Wall

56. Extra-abdominal Multilocular Fibrocystoma of the Ovary

57. An Extra- abdominal Multilocular Fibrocystoma

58. Superficial Lymphatics of the Umbilical Region

59. The Deep Umbilical Lymphatics as Seen from the Peritoneal Side

60. The Umbilical Vessels about the Time of Birth

61. The Umbilical Vessels in the Adult

62. 63. Method of Treating the Umbilical Stump at Birth

64. Nature's Method of Checking Bleeding from the Umbilical Arteries

65. An Umbilical Granulation

66. The Gradual Atrophy of the Omphalomesenteric Duct

67. An Umbilical Polyp Connected with Meckel's Diverticulum by a Fibrous Cord

68. An Umbilical Polyp Attached to the Small Bowel by a Fibrous Cord

69. An Umbilical Polyp on the Prominent Part of an Umbilical Hernia

70. A Polypoid Outgrowth from the Umbilicus

71. Tubular Glands from the Umbilical Polyp Shown in Fig. 70

72. A Diverticular Tumor at the Umbilicus

73. A Glandular Tumor from the Umbilicus

74. A Glandular Growth at the Umbilicus

75. Section in the Long Axis of a Small Umbilical Growth

76. Adenoma of the Umbilicus

77. Ax Umbilical Polyp Attached to a Meckel's Diverticulum by a Fibrous Cord

78. Ax Umbilical Polyp Attached to a Meckel's Diverticulum by a Fibrous Cord

79. An Umbilical Polyp

80. A Small Intestinal Polyp Almost Fillingthb Umbilical Depression

81. An Umbilical Polyp

82. Portion of an Intestinal Polyp Partially Filling the Umbilical Depression

83. Transverse Section op a Pseudopyloric Congenital Fistula at the Umbilicus

84. High-power Picture op a Fistulous Tract at the Umbilicus, Showing Glands Resembling those of the Pylorus

85. An Umbilical Fistula Lined with Mucosa Resembling that of the Stomach

86. Appearance of the Umbilical Depression in von Rosthorn's Case

87. Gastric Mucosa at the Umbilicus

88. Appearance of the Umbilicus After Removal of the Stomach Mucosa Seen in Fig. 87

89. Persistence of the Outer End of the Omphalomesenteric Duct

90. Atrophy of the Inner End of the Omphalomesenteric Duct

91. A Long Umbilical Polyp as a Remnant of the Omphalomesenteric Duct

92. Meckel's Diverticulum

93. A Meckel's Diverticulum Attached to the Abdominal Wall at the Umbilicus

94. An Abnormally Large Meckel's Diverticulum

95. A Meckel's Diverticulum with a Lobulated Extremity

96. A Meckel's Diverticulum with Hernial Protrusions from Its Surface

97. A Short Meckel's Diverticulum Springing from the Mesenteric Attachment

98. An Accessory Pancreas in the Tip of Meckel's Diverticulum

99. A Meckel's Diverticulum Completely Tying off a Loop of Small Bowel

100. A Diverticulum Tying Off a Loop of Small Bowel

101. Strangulation of a Meckel's Diverticulum Causing Volvulus of the Ileum

102. Fatal Intestinal Obstruction Due to the Passage of the Bowel through a Hole in the Mesentery of a Meckel's Diverticulum

103. Inversion of a Meckel's Diverticulum into the Lumen of the Bowel

104. A Well-developed Loop of Small Bowel in a Dermoid Cyst of the Ovary

105. An Intestinal Cyst

106. An Intestinal Cyst Attached to the Umbilicus by a Pedicle but not Connected with the Bowel

107. Volvulus of Meckel's Diverticulum

108. An Intestinal Cyst Developing from Meckel's Diverticulum

109. Intestinal Cysts in the Abdominal Cavity

1 10. An Intramesenteric Cyst

111. A Patent Omphalomesenteric Duct

112. A Patent Omphalomesenteric Duct with a Polypoid Formation at the Umbilicus

113. A Very Short Omphalomesenteric Duct

114. A Patent Omphalomesenteric Duct with a Polyp-like Formation at the Umbilicus

1 15. A Patent Omphalomesenteric Duct

116. A Patent Omphalomesenteric Duct

117. A Patent Omphalomesenteric Duct

118. A Patent Omphalomesenteric Duct

119. A Patent Omphalomesenteric Duct

120. A Patent Omphalomesenteric Duct

121. A Patent Omphalomesenteric Duct

122. Part of a Patent Omphalomesenteric Duct

123. Intestinal Mucosa Covering the Cutaneous or Umbilical End of a Patent Omphalomesenteric Duct

124. An Umbilical Polyp and a Fibrous Nodule at the Umbilicus. There was Originally a Patent Omphalomesenteric Duct

125. Longitudinal Section through the Entire Center of a Partially Closed Omphalomesenteric Duct

126. A Patent Omphalomesenteric Duct

127. A Patent Omphalomesenteric Duct Opening at the Base of the Umbilical Cord

128. A Patent Omphalomesenteric Duct

129. A Patent Omphalomesenteric Duct as Seen from the Abdominal Cavity

130. Inversion of the Bowel through a Patent Omphalomesenteric Duct Opening on the Side of the Umbilical Cord

131. A Patent Omphalomesenteric Duct of Large Diameter

132. Commencing Prolapsus of Small Bowel through a Patent Omphalomesenteric Duct

133. Partial Prolapsus of the Small Bowel through the Omphalomesenteric Duct

134. Prolapsus of the Small Bowel through the Patent Omphalomesenteric Duct

135. Complete Prolapsus of the Bowel through the Patent Omphalomesenteric Duct

136. Prolapsus of the Small Bowel through the Patent Omphalomesenteric Duct, and an Umbilical Hernia between the Loops of Prolapsed Bowel

137. Prolapse of the Small Bowel through an Open Omphalomesenteric Duct

138. Prolapsus of the Bowel through a Patent Omphalomesenteric Duct

139. Prolapsus of the Bowel through a Patent Omphalomesenteric Duct, with Secondary Complications

140. Prolapsus and Inversion of the Intestine through a Patent Omphalomesenteric Duct

141. Prolapsus of the Bowel through the Patent Omphalomesenteric Duct

142. A Small Cyst of the Umbilicus Due to a Remnant of the Omphalomesenteric Duct

143. Small Cyst of the Abdominal Wall Due to a Remnant of the Omphalomesenteric Duct

144. A Small Intestinal Cyst Lying between the Peritoneum and the Recti

145. An Omphalomesenteric Duct Originating from the Concave Side of the Bowel and Attached to the Umbilicus by a Fibrous Cord

146. A Remnant of an Omphalomesenteric Duct Causing Fatal Intestinal Obstruction

147. A Small Umbilical Concretion

148. Acute Inflammation of the Umbilicus Due to an Accumulation of Sebaceous Material

149. Cholesteatoma from the Umbilicus in Case 1

150. Cholesteatoma from Case 2

151. A Connective-tissue Projection Really Representing a Small Fibroma in the Floor of the Umbilicus

152. Enlargement of Fig. 151

153. Subumbilical Phlegmon

154. The Subumbilical Space

155. Paget's Disease of the Umbilicus

156. Paget's Disease of the U/mbilicus

157. Paget's Disease of the Umbilicus

158. Paget's Disease of the Umbilicus

159. The Appearance in a Case of Paget's Disease of the Umbilicus After Treatment with Radium

160. Syphilis of the Umbilicus

161. Atrophic Tuberculid Starting at the Umbilicus

162. Leakage from an Abdominal Aneurysm Producing a Temporary Abdominal Tumor; Subsequent Escape of the Blood into the Right Renal Pocket

163. The Manner in Which a Periprostatic Abscess may Occasionally Rupture at the Umbilicus

164. Escape of Pleural Fluid from the Umbilicus

165. The Opening of a Broad Ligament Abscess at the Umbilicus

166. Abdominal Pregnancy with Spontaneous Escape of Liquor Amnii from the Umbilicus

167. Small Papilloma in the Umbilical Depression

168. A Shall Umbilical Tumor Containing Glands and Stroma Identical with Those of the Uterine Mucosa

169. Glands from a Small Umbilical Tumor

170. Typical Uterine Mucosa in a Small Umbilical Tumor. An Enlargement of Area B in Fig. 168

171. Glands in a Small Umbilical Tumor

172. Dilated Glands in a Small Umbilical Tumor

173. Dichotomous Branching of Glands in a Small Umbilical Tumor

174. Uterine Glands in an Umbilical Tumor

175. Gland Hypertrophy in a Small Umbilical Tumor

176. A Tumor of the Umbilicus Composed Partly of Hypertrophic Sweat-glands

177. Uterine Mucosa in an Umbilical Tumor

178. A Small Umbilical Tumor Containing Numerous Glands

179. Glands in a Small Umbilical Tumor

180. An Adenomyoma in the Abdominal Wall Near the Anterior Iliac Spine

181. A Small Umbilical Tumor Containing Glands Similar to Those of the Body of the Uterus

182. Adenomyoma of the Umbilicus

183. A Group of Sweat-glands in an Umbilical Tumor

184. Appearance of the Carcinomatous Umbilicus After Removal

185. Carcinoma of the Umbilicus Secondary to Carcinoma of the Ovaries

186. A Malignant Growth of the Umbilicus, Apparently a Carcinoma Secondary to Some Abdominal Growth

187. Adenocarcinoma of the Umbilicus Secondary to an Intra-abdominal Growth

188. Adenocarcinoma of the Umbilicus

189. A Section Showing Carcinoma of the Right Inguinal Glands

190. Secondary Carcinoma of the Umbilicus

191. Telangiectatic Myxosarcoma of the Umbilicus

192. Appearance of the Umbilicus After Removal of the Tumor Shown in Fig. 191

193. Myxosarcoma of the Umbilicus

194. Telangiectatic Myxosarcoma Projecting from the Right Side of the Umbilicus

195. A Telangiectatic Myxosarcoma

196. A Case of Congenital Umbilical Hernia

197. An Amniotic Hernia

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

199. A Serous Umbilical Hernia

200. Freeing the Umbilical Hernial Sac from the Abdomen

201. Closure of the Hernial Opening at the Umbilicus

202. Closure of the Hernial Opening at the Umbilicus

203. An Umbilical Hernia Associated with Marked Prolapsus of the Abdominal Wall

204. An Umbilical Hernia and a Markedly Pendulous Abdomen in a Patient Weighing 464 Pounds

205. The Abdominal Scar After the Removal of a Very Large Area of Fat

206. An Umbilical Cyst

207. Exstrophy of the Bladder Opening at or Near the Umbilicus

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

209. Exstrophy of the Bladder

210. Escape of Urine from the Umbilicus When the Inner Urethral Orifice Is Blocked by a Membrane

211. A Patent Urachus with a Mushroom-like Projection at the Umbilicus

212. A Patent Urachus with a Penile Projection at the Umbilicus

213. The Appearance of the Umbilicus in a Case in Which both a Patent Omphalomesenteric Duct and a Patent Urachus Existed

214. Cross-section of the Patent Omphalomesenteric Duct and of the Patent Urachus in the Same Child

215. A Picture of the Child Three Weeks After Removal of a Patent Omphalomesenteric Duct and a Patulous Urachus

216. A Patent Urachus

217. A Urachus Open from Bladder to Umbilicus

218. An Open Urachus

219. Escape of Urine from the Umbilicus Due to a Patent Urachus

220. A Patent Urachus with a Penile Projection at the Umbilicus

221. A Ring-shaped Vesical Calculus with a Fine Hair in Its Axis

222. A Partially Patent Urachus

223. A Patent Urachus

224. A Portion of a Urachus Seven Times Enlarged, with Numerous Large and Small Dilatations

225. Portion of a Urachus Ten Times Enlarged

226. Cysts of the Urachus Arranged Like a String of Pearls

227. Spindle-Shaped Dilatations of the Urachus

228. A Small Cyst of the Urachus

229. A Patent Urachus

230. A Multilocular Cyst of the Urachus

231. Section of a Patent Urachus

232. Transverse Section of a Patent Urachus

233. A Small Cyst of the Urachus

234. A Diffuse Neuroma of the Bladder

235. Cut Surface of the Bladder Showing a Diffuse Neuroma of Its Walls

236. A Diffuse Neuroma Forming a Mantle Around the Cavity of the Bladder

237. Diagram Showing the Arrested Development of the Genital Tract and the Relation of the Malformed Parts to the Cyst of the Urachus

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

240. A Urachal Cyst Turned Inside Out and Showing Papillary Masses, Particularly in the Lower Part of the Picture 559

241. Infected Urachal Remains

242. An Infected Urachus Opening between the Umbilicus and Bladder

243. Urachal Cyst

244. A Dilated Urachus Communicating with the Bladder

245. Large Accumulation of Urine in a Partially Patent Urachus

246. An Infected Urachus Opening at the Umbilicus

247. A Patent Urachus Dilated in Its Middle Portion

248. Accumulation of a Large Quantity of Urine in a Urachal Pouch

249. Fetal Bones Removed from an Old Extra-uterine Pregnancy Sac

250. A Phosphatic Deposit on the End of a Long Bone

251. A Dilated Urachus Communicating with the Bladder

252. Urachal Cyst

253. Urachal Cyst

254. Urachal Cyst

255. A Patent Urachus Containing a Vesical Calculus

256. Carcinoma of the Patent Urachus

257. A Multilocular and Malignant Cyst of the Urachus

258. Giant-cells in the Wall of an Adenocarcinomatous Cyst of the Urachus

259. Giant-cells in the Wall of an Adenocarcinoma of the Urachus

260. Giant-cells in the Wall of an Adenocarcinomatous Cyst of the Urachus

261. Adenocarcinoma of the Urachus

262. A Papillary-like Area in an Adkxocarcinomatous Cystofthe Urachus

263. Metastasis from Adenocarcinoma of the Urachus

264. An Umbilical Cyst

265. \\ aj.i of an Umbilical Cyst

266. Giant-cells in the Wall of an Umbilical Cyst

267. Tuberculosis of the Urachus

268. An Area Suggesting a Tubercle

269. A Tubercle from Dr. Eastman's Case of Tuberculosis of the Urachus

List of Plates

List of Plates


  1. Drawings of Normal Umbilici
  2. Drawings of Normal Umbilici
  3. Drawings of Normal Umbilici
  4. Drawings of Normal Umbilici
  5. Cancer of the Umbilicus Apparently Secondary to a Tumor of the Ovary
  6. Umbilical Hernia
  7. Exstrophy of the Bladder


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, April 28) Embryology Book - Umbilicus (1916). Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Book_-_Umbilicus_(1916)

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