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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Pages where the terms "Historic" (textbooks, papers, people, recommendations) appear on this site, and sections within pages where this disclaimer appears, indicate that the content and scientific understanding are specific to the time of publication. This means that while some scientific descriptions are still accurate, the terminology and interpretation of the developmental mechanisms reflect the understanding at the time of original publication and those of the preceding periods, these terms, interpretations and recommendations may not reflect our current scientific understanding.     (More? Embryology History | Historic Embryology Papers)

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

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

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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