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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}}
 
<br><br>
# [[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
 
3. A Composite Picture Showing the Formation of the Umbilicus in an Embryo 3
 
4. A Diagrammatic Representation of a Human Embryo, about 3.5 mm. Long, Show
ing the Effect of the Expanding Amnion upon the Yolk-sac and Body-stalk ... 4
 
5. Sagittal View of a Human Embryo 5 mm. in Length 5


6. Anterior View and Transverse Section of a Human Embryo 7 mm. Long, Showing
1. Sagittal Section Showing a Very Early Stage in the Formation of the Umbilicus  and allantois


the Umbilical Region 6
2. A More Advanced Stage in the Formation of the Umbilical Region


7. Sagittal Section of the Umbilical Region in an Embryo 7 mm. in Length 7
3. A Composite Picture Showing the Formation of the Umbilicus in an Embryo


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


9. Graphic Reconstruction of the Umbilical Cord of a Human Embryo 12.5 mm. in  
5. Sagittal View of a Human Embryo 5 mm. in Length


Length 9
6. Anterior View and Transverse Section of a Human Embryo 7 mm. Long, Showing the Umbilical Region


10. Anterior View of the Umbilical Cord of a Human Embryo 18 mm. in Length 10
7. Sagittal Section of the Umbilical Region in an Embryo 7 mm. in Length  


11. Sagittal Section of the Umbilical Region in a Human Embryo 23 mm. in Length .. 11
8. Sagittal View of the Umbilical Region of a Human Embryo 10 mm. in Length


12. A Graphic Reconstruction of the Umbilical Region of a Human Embryo 3 cm.  
9. Graphic Reconstruction of the Umbilical Cord of a Human Embryo 12.5 mm. in Length


Long 12
10. Anterior View of the Umbilical Cord of a Human Embryo 18 mm. in Length


13. Sagittal Section of the Umbilical Region in a Human Embryo 4.5 cm. in Length .. 13
11. Sagittal Section of the Umbilical Region in a Human Embryo 23 mm. in Length


14. A Graphic Reconstruction of the Umbilical Region of a Human Embryo 4.5 cm.  
12. A Graphic Reconstruction of the Umbilical Region of a Human Embryo 3 cm. Long


in Length as Viewed from within the Abdomen 14
13. Sagittal Section of the Umbilical Region in a Human Embryo 4.5 cm. in Length


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


Embryo 5.2 cm. in Length 15  
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  
16. Intra-abdominal View of the Umbilical Region of a Human Embryo 6.5 cm. in Length


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


17. Intra-abdominal View of the Umbilical Region in a Human Embryo 7.5 cm. Long . . 18
18. Intra-abdominal View of the Umbilical Region in a Human Embryo 9 cm. in Length


18. Intra-abdominal View of the Umbilical Region in a Human Embryo 9 cm. in  
19. Intra-abdominal View of the Umbilical Region in a Human Embryo 10 cm. in Length


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


19. Intra-abdominal View of the Umbilical Region in a Human Embryo 10 cm. in  
21. Intra-abdominal View of the Umbilical Region in a Human Embryo 12 cm. in Length


Length 19
22. Intra-abdominal View of the Umbilical Region in a Human Embryo 12 cm. in Length


20. Intra-abdominal View of the Umbilical Region in a Human Embryo 12 cm. Long . . 19
23. Cross-section of the Umbilical Cord at the Umbilicus in a Human Embryo 12 cm. in Length


21. Intra-abdominal View of the Umbilical Region in a Human Embryo 12 cm. in
24. Internal View of the Umbilical Region in a Human Embryo 15 cm. Long


Length 20
25. A Composite Representation of Abnormal Umbilical Structures, Based on the Work of Keibel, Lowy, and Others


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


Length 21
27. A Composite Representation of Abnormal Umbilical Structures, Based on the Work of Keibel, Lowy, and Others


23. Cross-section of the Umbilical Cord at the Umbilicus in a Human Embryo 12 cm.
28. The Umbilical Region in a Fetus about Five Months Old Viewed from the Left


in Length 22
29. Side and Posterior Views of the Umbilical Region in a Fetus of Six to Seven Months


24. Internal View of the Umbilical Region in a Human Embryo 15 cm. Long 23
30. Three Diagrams of the Umbilical Ring and Its Significance in the Development of Ventral Hernia


25. A Composite Representation of Abnormal Umbilical Structures, Based on the  
31. The Appearance of the Yolk-sac (Umbilical Vesicle) in a Pregnancy, with the Embryo 5.5 cm. Long


Work of Keibel, Lowy, and Others 24
32. The Umbilical Region, the Cord, and the Placenta at Term


26. A Composite Representation of Abnormal Umbilical Structures, Based on the
33. A Diagrammatic Representation of the Umbilical Region of a Fetus at Term


Work of Keibel, Lowy, and Others 24
34. Normal Umbilicus according to Catteau


27. 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


28. The Umbilical Region in a Fetus about Five Months Old Viewed from the Left . . 25
37. The Umbilical Region of an Adult, Viewed from Within


29. Side and Posterior Views of the Umbilical Region in a Fetus of Six to Seven
38. Classic Type of Umbilicus


Months 25
39. Disposition of the Vascular Cords (Usual Type)


30. Three Diagrams of the Umbilical Ring and Its Significance in the Development
40. Vascular Cords of the Anastomosing Type, Noted 7 Times in 50 Cases


of Ventral Hernia 27
41. Vascular Cord Type, Noted 5 Times in 50 Cases


XV
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


XVI LIST OF ILLUSTRATIONS
45. Umbilical Fascia. Peritoneum in Place


Fig. Page
46. Umbilical Fascia and Umbilical Mesentery


31. The Appearance of the Yolk-sac (Umbilical Vesicle) in a Pregnancy, with the
47. Reduplication of the Linea Alba. Peritoneum Removed


Embryo 5.5 cm. Long 28
48. Atrophy of the Umbilical Fascia, Posterior View


32. The Umbilical Region, the Cord, and the Placenta at Term 29
49. Formation of a Mesentery. Peritoneum in Place


33. A Diagrammatic Representation of the Umbilical Region of a Fetus at Term .... 32
50. Mesentery of the Urachus and of the Umbilical Arteries


34. Normal Umbilicus according to Catteau 35
51. Adipose Fringes. From a Well-developed Young Woman. Peritoneum in Place


35. A Type of Umbilical Region in the Adult, Viewed from Within 44
52. Adipose Fringes in a Stout Subject. Peritoneum in Place


36. A Frequent Type of the Umbilical Region in the Adult, Viewed from Within .... 44
53. Peritoneal Diverticula. Peritoneum in Place


37. The Umbilical Region of an Adult, Viewed from Within 45
54. Peri-umbilical Fossettes. Peritoneum in Place


38. Classic Type of Umbilicus 47
55. Ovarian Pedicle Passing from Uterus out through a Hernial Ring in the Abdominal Wall


39. Disposition of the Vascular Cords (Usual Type) 48
56. Extra-abdominal Multilocular Fibrocystoma of the Ovary


40. Vascular Cords of the Anastomosing Type, Noted 7 Times in 50 Cases 48
57. An Extra- abdominal Multilocular Fibrocystoma


41. Vascular Cord Type, Noted 5 Times in 50 Cases 49
58. Superficial Lymphatics of the Umbilical Region


42. Vascular Cords, Noted 5 Times in 50 Cases, Completely Filling the Umbilical
59. The Deep Umbilical Lymphatics as Seen from the Peritoneal Side


Ring 49
60. The Umbilical Vessels about the Time of Birth


43. Vascular Cords, Noted 3 Times in 50 Cases 49
61. The Umbilical Vessels in the Adult


44. Vascular Cords, Noted in 2 out of 50 Cases 50
62. 63. Method of Treating the Umbilical Stump at Birth


45. Umbilical Fascia. Peritoneum in Place 52
64. Nature's Method of Checking Bleeding from the Umbilical Arteries


46. Umbilical Fascia and Umbilical Mesentery 52
65. An Umbilical Granulation


47. Reduplication of the Linea Alba. Peritoneum Removed 52
66. The Gradual Atrophy of the Omphalomesenteric Duct


48. Atrophy of the Umbilical Fascia, Posterior View 53
67. An Umbilical Polyp Connected with Meckel's Diverticulum by a Fibrous Cord


49. Formation of a Mesentery. Peritoneum in Place 53
68. An Umbilical Polyp Attached to the Small Bowel by a Fibrous Cord


50. Mesentery of the Urachus and of the Umbilical Arteries 53
69. An Umbilical Polyp on the Prominent Part of an Umbilical Hernia


51. Adipose Fringes. From a Well-developed Young Woman. Peritoneum in Place 54
70. A Polypoid Outgrowth from the Umbilicus


52. Adipose Fringes in a Stout Subject. Peritoneum in Place 54
71. Tubular Glands from the Umbilical Polyp Shown in Fig. 70


53. Peritoneal Diverticula. Peritoneum in Place 55
72. A Diverticular Tumor at the Umbilicus


54. Peri-umbilical Fossettes. Peritoneum in Place 55
73. A Glandular Tumor from the Umbilicus


55. Ovarian Pedicle Passing from Uterus out through a Hernial Ring in the Ab
74. A Glandular Growth at the Umbilicus
dominal Wall 57


56. Extra-abdominal Multilocular Fibrocystoma of the Ovary 5S
75. Section in the Long Axis of a Small Umbilical Growth


57. An Extra- abdominal Multilocular Fibrocystoma 59
76. Adenoma of the Umbilicus


58. Superficial Lymphatics of the Umbilical Region 64
77. Ax Umbilical Polyp Attached to a Meckel's Diverticulum by a Fibrous Cord


59. The Deep Umbilical Lymphatics as Seen from the Peritoneal Side 65
78. Ax Umbilical Polyp Attached to a Meckel's Diverticulum by a Fibrous Cord


60. The Umbilical Vessels about the Time of Birth 72
79. An Umbilical Polyp


61. The Umbilical Vessels in the Adult 72
80. A Small Intestinal Polyp Almost Fillingthb Umbilical Depression


62. 63. Method of Treating the Umbilical Stump at Birth 98
81. An Umbilical Polyp


64. Nature's Method of Checking Bleeding from the Umbilical Arteries 107
82. Portion of an Intestinal Polyp Partially Filling the Umbilical Depression


65. An Umbilical Granulation 117
83. Transverse Section op a Pseudopyloric Congenital Fistula at the Umbilicus


66. The Gradual Atrophy of the Omphalomesenteric Duct 121
84. High-power Picture op a Fistulous Tract at the Umbilicus, Showing Glands Resembling those of the Pylorus


67. An Umbilical Polyp Connected with Meckel's Diverticulum by a Fibrous Cord . . 121
85. An Umbilical Fistula Lined with Mucosa Resembling that of the Stomach


68. An Umbilical Polyp Attached to the Small Bowel by a Fibrous Cord 121
86. Appearance of the Umbilical Depression in von Rosthorn's Case


69. An Umbilical Polyp on the Prominent Part of an Umbilical Hernia : . . 123
87. Gastric Mucosa at the Umbilicus


70. A Polypoid Outgrowth from the Umbilicus 129
88. Appearance of the Umbilicus After Removal of the Stomach Mucosa Seen in Fig. 87


71. Tubular Glands from the Umbilical Polyp Shown in Fig. 70 129
89. Persistence of the Outer End of the Omphalomesenteric Duct


72. A Diverticular Tumor at the Umbilicus 132
90. Atrophy of the Inner End of the Omphalomesenteric Duct


73. A Glandular Tumor from the Umbilicus 132
91. A Long Umbilical Polyp as a Remnant of the Omphalomesenteric Duct


74. A Glandular Growth at the Umbilicus 133
92. Meckel's Diverticulum


75. Section in the Long Axis of a Small Umbilical Growth 134
93. A Meckel's Diverticulum Attached to the Abdominal Wall at the Umbilicus


76. Adenoma of the Umbilicus 135
94. An Abnormally Large Meckel's Diverticulum


77. Ax Umbilical Polyp Attached to a Meckel's Diverticulum by a Fibrous Cord. 138
95. A Meckel's Diverticulum with a Lobulated Extremity


78. Ax Umbilical Polyp Attached to a Meckel's Diverticulum by a Fibrous Cord . . . 138
96. A Meckel's Diverticulum with Hernial Protrusions from Its Surface


79. An Umbilical Polyp 139
97. A Short Meckel's Diverticulum Springing from the Mesenteric Attachment


80. A Small Intestinal Polyp Almost Fillingthb Umbilical Depression 139
98. An Accessory Pancreas in the Tip of Meckel's Diverticulum


81. An Umbilical Polyp 140
99. A Meckel's Diverticulum Completely Tying off a Loop of Small Bowel


82. Portion of an Intestinal Polyp Partially Filling the Umbilical Depression .... 141
100. A Diverticulum Tying Off a Loop of Small Bowel


83. Transverse Section op a Pseudopyloric Congenital Fistula at the Umbilicus . . . . 149
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


LIST OF ILLUSTRATIONS XV11
104. A Well-developed Loop of Small Bowel in a Dermoid Cyst of the Ovary


Fia. Fage
105. An Intestinal Cyst


84. High-power Picture op a Fistulous Tract at the Umbilicus, Showing Glands Re
106. An Intestinal Cyst Attached to the Umbilicus by a Pedicle but not Connected with the Bowel
sembling those of the Pylorus 150


85. An Umbilical Fistula Lined with Mucosa Resembling that of the Stomach 150
107. Volvulus of Meckel's Diverticulum


86. Appearance of the Umbilical Depression in von Rosthorn's Case 152
108. An Intestinal Cyst Developing from Meckel's Diverticulum


87. Gastric Mucosa at the Umbilicus 153
109. Intestinal Cysts in the Abdominal Cavity


88. Appearance of the Umbilicus After Removal of the Stomach Mucosa Seen in
1 10. An Intramesenteric Cyst


Fig. 87 154
111. A Patent Omphalomesenteric Duct


89. Persistence of the Outer End of the Omphalomesenteric Duct 156
112. A Patent Omphalomesenteric Duct with a Polypoid Formation at the Umbilicus


90. Atrophy of the Inner End of the Omphalomesenteric Duct 156
113. A Very Short Omphalomesenteric Duct


91. A Long Umbilical Polyp as a Remnant of the Omphalomesenteric Duct 156
114. A Patent Omphalomesenteric Duct with a Polyp-like Formation at the Umbilicus


92. Meckel's Diverticulum 159
1 15. A Patent Omphalomesenteric Duct


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


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


95. A Meckel's Diverticulum with a Lobulated Extremity 161
118. A Patent Omphalomesenteric Duct


96. A Meckel's Diverticulum with Hernial Protrusions from Its Surface 162
119. A Patent Omphalomesenteric Duct


97. A Short Meckel's Diverticulum Springing from the Mesenteric Attachment . . 163
120. A Patent Omphalomesenteric Duct


98. An Accessory Pancreas in the Tip of Meckel's Diverticulum 163
121. A Patent Omphalomesenteric Duct


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


100. A Diverticulum Tying Off a Loop of Small Bowel 165
123. Intestinal Mucosa Covering the Cutaneous or Umbilical End of a Patent Omphalomesenteric Duct


101. Strangulation of a Meckel's Diverticulum Causing Volvulus of the Ileum. . . . 166
124. An Umbilical Polyp and a Fibrous Nodule at the Umbilicus. There was Originally a Patent Omphalomesenteric Duct


102. Fatal Intestinal Obstruction Due to the Passage of the Bowel through a  
125. Longitudinal Section through the Entire Center of a Partially Closed Omphalomesenteric Duct


Hole in the Mesentery of a Meckel's Diverticulum .170
126. A Patent Omphalomesenteric Duct


103. Inversion of a Meckel's Diverticulum into the Lumen of the Bowel 171
127. A Patent Omphalomesenteric Duct Opening at the Base of the Umbilical Cord


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


105. An Intestinal Cyst 176
129. A Patent Omphalomesenteric Duct as Seen from the Abdominal Cavity


106. An Intestinal Cyst Attached to the Umbilicus by a Pedicle but not Connected
130. Inversion of the Bowel through a Patent Omphalomesenteric Duct Opening on the Side of the Umbilical Cord


with the Bowel 176
131. A Patent Omphalomesenteric Duct of Large Diameter


107. Volvulus of Meckel's Diverticulum 177
132. Commencing Prolapsus of Small Bowel through a Patent Omphalomesenteric Duct


108. An Intestinal Cyst Developing from Meckel's Diverticulum 178
133. Partial Prolapsus of the Small Bowel through the Omphalomesenteric Duct


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


1 10. An Intramesenteric Cyst 183
135. Complete Prolapsus of the Bowel through the Patent Omphalomesenteric Duct


111. A Patent Omphalomesenteric Duct 190
136. Prolapsus of the Small Bowel through the Patent Omphalomesenteric Duct, and an Umbilical Hernia between the Loops of Prolapsed Bowel


112. A Patent Omphalomesenteric Duct with a Polypoid Formation at the Umbilicus . 190
137. Prolapse of the Small Bowel through an Open Omphalomesenteric Duct


113. A Very Short Omphalomesenteric Duct 190
138. Prolapsus of the Bowel through a Patent Omphalomesenteric Duct


114. A Patent Omphalomesenteric Duct with a Polyp- like Formation at the Umbil
139. Prolapsus of the Bowel through a Patent Omphalomesenteric Duct, with Secondary Complications
icus 190


1 15. A Patent Omphalomesenteric Duct 192
140. Prolapsus and Inversion of the Intestine through a Patent Omphalomesenteric Duct


116. A Patent Omphalomesenteric Duct 193
141. Prolapsus of the Bowel through the Patent Omphalomesenteric Duct  


1 17. A Patent Omphalomesenteric Duct 197
142. A Small Cyst of the Umbilicus Due to a Remnant of the Omphalomesenteric Duct


118. A Patent Omphalomesenteric Duct 197
143. Small Cyst of the Abdominal Wall Due to a Remnant of the Omphalomesenteric Duct


119. A Patent Omphalomesenteric Duct 202
144. A Small Intestinal Cyst Lying between the Peritoneum and the Recti


120. A Patent Omphalomesenteric Duct 205
145. An Omphalomesenteric Duct Originating from the Concave Side of the Bowel and Attached to the Umbilicus by a Fibrous Cord


121. A Patent Omphalomesenteric Duct 206
146. A Remnant of an Omphalomesenteric Duct Causing Fatal Intestinal Obstruction


122. Part of a Patent Omphalomesenteric Duct 206
147. A Small Umbilical Concretion


123. Intestinal Mucosa Covering the Cutaneous or Umbilical End of a Patent Om
148. Acute Inflammation of the Umbilicus Due to an Accumulation of Sebaceous Material
phalomesenteric Duct 207


124. An Umbilical Polyp and a Fibrous Nodule at the Umbilicus. There was Origin
149. Cholesteatoma from the Umbilicus in Case 1
ally a Patent Omphalomesenteric Duct 209


125. Longitudinal Section through the Entire Center of a Partially Closed Om
150. Cholesteatoma from Case 2 
phalomesenteric Duct 209


126. A Patent Omphalomesenteric Duct 211
151. A Connective-tissue Projection Really Representing a Small Fibroma in the Floor of the Umbilicus


127. A Patent Omphalomesenteric Duct Opening at the Base of the Umbilical Cord . . 216
152. Enlargement of Fig. 151


128. A Patent Omphalomesenteric Duct 216
153. Subumbilical Phlegmon


129. A Patent Omphalomesenteric Duct as Seen from the Abdominal Cavity 216
154. The Subumbilical Space


130. Inversion of the Bowel through a Patent Omphalomesenteric Duct Opening on the Side of the Umbilical Cord 219
155. Paget's Disease of the Umbilicus


131. A Patent Omphalomesenteric Duct of Large Diameter 224
156. Paget's Disease of the U/mbilicus


132. Commencing Prolapsus of Small Bowel through a Patent Omphalomesenteric Duct 224
157. Paget's Disease of the Umbilicus


133. Partial Prolapsus of the Small Bowel through the Omphalomesenteric Duct . . . 224
158. Paget's Disease of the Umbilicus


134. Prolapsus of the Small Bowel through the Patent Omphalomesenteric Duct .... 224
159. The Appearance in a Case of Paget's Disease of the Umbilicus After Treatment with Radium


135. Complete Prolapsus of the Bowel through the Patent Omphalomesenteric Duct 225
160. Syphilis of the Umbilicus


136. Prolapsus of the Small Bowel through the Patent Omphalomesenteric Duct, and an Umbilical Hernia between the Loops of Prolapsed Bowel 225
161. Atrophic Tuberculid Starting at the Umbilicus


137. Prolapse of the Small Bowel through an Open Omphalomesenteric Duct 227
162. Leakage from an Abdominal Aneurysm Producing a Temporary Abdominal Tumor; Subsequent Escape of the Blood into the Right Renal Pocket


138. Prolapsus of the Bowel through a Patent Omphalomesenteric Duct 228
163. The Manner in Which a Periprostatic Abscess may Occasionally Rupture at the Umbilicus


139. Prolapsus of the Bowel through a Patent Omphalomesenteric Duct, with Sec
164. Escape of Pleural Fluid from the Umbilicus
ondary Complications 229


140. Prolapsus and Inversion of the Intestine through a Patent Omphalomesenteric Duct 230
165. The Opening of a Broad Ligament Abscess at the Umbilicus


141. Prolapsus of the Bowel through the Patent Omphalomesenteric Duct 232
166. Abdominal Pregnancy with Spontaneous Escape of Liquor Amnii from the Umbilicus


142. A Small Cyst of the Umbilicus Due to a Remnant of the Omphalomesenteric Duct 238
167. Small Papilloma in the Umbilical Depression


143. Small Cyst of the Abdominal Wall Due to a Remnant of the Omphalomesenteric Duct 238
168. A Shall Umbilical Tumor Containing Glands and Stroma Identical with Those of the Uterine Mucosa


144. A Small Intestinal Cyst Lying between the Peritoneum and the Recti 240
169. Glands from 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
170. Typical Uterine Mucosa in a Small Umbilical Tumor. An Enlargement of Area B in Fig. 168


146. A Remnant of an Omphalomesenteric Duct Causing Fatal Intestinal Obstruction 245
171. Glands in a Small Umbilical Tumor


147. A Small Umbilical Concretion 249
172. Dilated Glands in a Small Umbilical Tumor


148. Acute Inflammation of the Umbilicus Due to an Accumulation of Sebaceous Material 249
173. Dichotomous Branching of Glands in a Small Umbilical Tumor


149. Cholesteatoma from the Umbilicus in Case 1 251
174. Uterine Glands in an Umbilical Tumor


150. Cholesteatoma from Case 2 251
175. Gland Hypertrophy in a Small Umbilical Tumor


151. A Connective-tissue Projection Really Representing a Small Fibroma in the Floor of the Umbilicus 252
176. A Tumor of the Umbilicus Composed Partly of Hypertrophic Sweat-glands


152. Enlargement of Fig. 151 252
177. Uterine Mucosa in an Umbilical Tumor


153. Subumbilical Phlegmon 262
178. A Small Umbilical Tumor Containing Numerous Glands


154. The Subumbilical Space 264
179. Glands in a Small Umbilical Tumor


155. Paget's Disease of the Umbilicus 270
180. An Adenomyoma in the Abdominal Wall Near the Anterior Iliac Spine


156. Paget's Disease of the U/mbilicus 270
181. A Small Umbilical Tumor Containing Glands Similar to Those of the Body of the Uterus


157. Paget's Disease of the Umbilicus 271
182. Adenomyoma of the Umbilicus


158. Paget's Disease of the Umbilicus 274
183. A Group of Sweat-glands in an Umbilical Tumor


159. The Appearance in a Case of Paget's Disease of the Umbilicus After Treatment with Radium 275
184. Appearance of the Carcinomatous Umbilicus After Removal


160. Syphilis of the Umbilicus 284
185. Carcinoma of the Umbilicus Secondary to Carcinoma of the Ovaries


161. Atrophic Tuberculid Starting at the Umbilicus 286
186. A Malignant Growth of the Umbilicus, Apparently a Carcinoma Secondary to Some Abdominal Growth


162. Leakage from an Abdominal Aneurysm Producing a Temporary Abdominal Tumor; Subsequent Escape of the Blood into the Right Renal Pocket 288
187. Adenocarcinoma of the Umbilicus Secondary to an Intra-abdominal Growth


163. The Manner in Which a Periprostatic Abscess may Occasionally Rupture at the Umbilicus 289
188. Adenocarcinoma of the Umbilicus


164. Escape of Pleural Fluid from the Umbilicus 289
189. A Section Showing Carcinoma of the Right Inguinal Glands


165. The Opening of a Broad Ligament Abscess at the Umbilicus 290
190. Secondary Carcinoma of the Umbilicus


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


167. Small Papilloma in the Umbilical Depression 365
192. Appearance of the Umbilicus After Removal of the Tumor Shown in Fig. 191


168. A Shall Umbilical Tumor Containing Glands and Stroma Identical with Those of the Uterine Mucosa 376
193. Myxosarcoma of the Umbilicus


169. Glands from a Small U\iisiLirALTuMOR 377
194. Telangiectatic Myxosarcoma Projecting from the Right Side of the Umbilicus


170. Typical Uterine Mucosa in a Small Umbilical Tumor. An Enlargement of Area B in Fig. 168 378
195. A Telangiectatic Myxosarcoma


171. Glands in a Small Umbilical Tumor 379
196. A Case of Congenital Umbilical Hernia


172. Dilated Glands in a Small Umbilical Tumor 380
197. An Amniotic Hernia


173. Dichotomous Branching of Glands in a Small Umbilical Tumor 381
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


174. Uterine Glands in an Umbilical Tumor 381
199. A Serous Umbilical Hernia


175. Gland Hypertrophy in a Small Umbilical Tumor 382
200. Freeing the Umbilical Hernial Sac from the Abdomen


176. A Tumor of the Umbilicus Composed Partly of Hypertrophic Sweat-glands 383
201. Closure of the Hernial Opening at the Umbilicus


177. Uterine Mucosa in an Umbilical Tumor 384
202. Closure of the Hernial Opening at the Umbilicus


178. A Small Umbilical Tumor Containing Numerous Glands 388
203. An Umbilical Hernia Associated with Marked Prolapsus of the Abdominal Wall


179. Glands in a Small Umbilical Tumor 389
204. An Umbilical Hernia and a Markedly Pendulous Abdomen in a Patient Weighing 464 Pounds


180. An Adenomyoma in the Abdominal Wall Near the Anterior Iliac Spine 394
205. The Abdominal Scar After the Removal of a Very Large Area of Fat


181. A Small Umbilical Tumor Containing Glands Similar to Those of the Body of the Uterus 396
206. An Umbilical Cyst


182. Adenomyoma of the Umbilicus 397
207. Exstrophy of the Bladder Opening at or Near the Umbilicus


183. A Group of Sweat-glands in an Umbilical Tumor 398
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


184. Appearance of the Carcinomatous Umbilicus After Removal 424
209. Exstrophy of the Bladder


185. Carcinoma of the Umbilicus Secondary to Carcinoma of the Ovaries 432
210. Escape of Urine from the Umbilicus When the Inner Urethral Orifice Is Blocked by a Membrane


186. A Malignant Growth of the Umbilicus, Apparently a Carcinoma Secondary to Some Abdominal Growth 439
211. A Patent Urachus with a Mushroom-like Projection at the Umbilicus


187. Adenocarcinoma of the Umbilicus Secondary to an Intra-abdominal Growth .... 440
212. A Patent Urachus with a Penile Projection at the Umbilicus


188. Adenocarcinoma of the Umbilicus 441
213. The Appearance of the Umbilicus in a Case in Which both a Patent Omphalomesenteric Duct and a Patent Urachus Existed


189. A Section Showing Carcinoma of the Right Inguinal Glands 442
214. Cross-section of the Patent Omphalomesenteric Duct and of the Patent Urachus in the Same Child


190. Secondary Carcinoma of the Umbilicus 443
215. A Picture of the Child Three Weeks After Removal of a Patent Omphalomesenteric Duct and a Patulous Urachus


191. Telangiectatic Myxosarcoma of the Umbilicus 450
216. A Patent Urachus


192. Appearance of the Umbilicus After Removal of the Tumor Shown in Fig. 191. . 450
217. A Urachus Open from Bladder to Umbilicus


193. Myxosarcoma of the Umbilicus 451
218. An Open Urachus


194. Telangiectatic Myxosarcoma Projecting from the Right Side of the Umbilicus . . 452
219. Escape of Urine from the Umbilicus Due to a Patent Urachus


195. A Telangiectatic Myxosarcoma 452
220. A Patent Urachus with a Penile Projection at the Umbilicus


196. A Case of Congenital Umbilical Hernia 460
221. A Ring-shaped Vesical Calculus with a Fine Hair in Its Axis


197. An Amniotic Hernia 462
222. A Partially Patent Urachus


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
223. A Patent Urachus


199. A Serous Umbilical Hernia 469
224. A Portion of a Urachus Seven Times Enlarged, with Numerous Large and Small Dilatations


200. Freeing the Umbilical Hernial Sac from the Abdomen 472
225. Portion of a Urachus Ten Times Enlarged


201. Closure of the Hernial Opening at the Umbilicus 473
226. Cysts of the Urachus Arranged Like a String of Pearls


202. Closure of the Hernial Opening at the Umbilicus 474
227. Spindle-Shaped Dilatations of the Urachus


203. An Umbilical Hernia Associated with Marked Prolapsus of the Abdominal Wall 475
228. A Small Cyst of the Urachus


204. An Umbilical Hernia and a Markedly Pendulous Abdomen in a Patient Weighing 464 Pounds 476
229. A Patent Urachus


205. The Abdominal Scar After the Removal of a Very Large Area of Fat 477
230. A Multilocular Cyst of the Urachus


206. An Umbilical Cyst 478
231. Section of a Patent Urachus


207. Exstrophy of the Bladder Opening at or Near the Umbilicus 482
232. Transverse Section of a Patent Urachus


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
233. A Small Cyst of the Urachus


209. Exstrophy of the Bladder 483
234. A Diffuse Neuroma of the Bladder


210. Escape of Urine from the Umbilicus When the Inner Urethral Orifice Is Blocked by a Membrane 488
235. Cut Surface of the Bladder Showing a Diffuse Neuroma of Its Walls


211. A Patent Urachus with a Mushroom-like Projection at the Umbilicus 489
236. A Diffuse Neuroma Forming a Mantle Around the Cavity of the Bladder


212. A Patent Urachus with a Penile Projection at the Umbilicus 489
237. Diagram Showing the Arrested Development of the Genital Tract and the Relation of the Malformed Parts to the Cyst of the Urachus
 
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
# [[:File:Cullen1916 plate01.jpg|Drawings of Normal Umbilici]]
# [[: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]]


VII. Exstrophy of the Bladder 484-485


{{Cullen1916 footer}}
{{Cullen1916 footer}}
[[Category:Draft]]
[[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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This historic 1916 textbook by Cullen describes the umbilical region.



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

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