Abstract
The umbilical cord remnant usually separates in the neonatal period and its persistence beyond the first couple of months is considered abnormal.
Umbilical abnormalities may present with failure of the umbilical cord to separate, omphalitis, mass lesions, or discharge. The commonest umbilical lesion in the neonate is an umbilical granuloma. Other abnormalities are umbilical polyps, omphalomesenteric duct and urachal remnants. It is essential to distinguish between these conditions in order to initiate appropriate treatment.
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References
Ente G, Penzer PH. The umbilical cord: normal parameters. J R Soc Health. 1991;111(4):138–40.
Snyder CL. Current management of umbilical abnormalities and related anomalies. Semin Pediatr Surg. 2007;16:41–9.
Pollak R. Adjunctive procedure in intestinal surgery. In: Fischer JE, editor. Mastery of surgery. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 1392–3.
Sharma R, Jain V. Emergency surgery for Meckel’s diverticulum. World J Emerg Surg. 2008;3:27.
Morgagni GB. The seats and causes of disease investigated by anatomy (Translated from the Latin by Benjamin Alexander). London: A Millar and T Cadell; 1769. p. 141.
Amos C. Meckel’s diverticulum: a pathological study of 63 cases. Am J Dis Child. 1931;42:544–53.
Hadley MN, Cogswell HD. Unusual origin of a Meckel’s diverticulum from the base of the appendix. JAMA. 1936;106:537–8.
Meckel JF. Uber die divertikel am darmkanal. Arch Physiol. 1809;9:421–53.
Gokhan Y, Sadettin C, Turgut T. Perforation of Meckel’s diverticulumby a chicken bone, a rare complication: report of a case. Surg Today. 2004;34:606–8.
Uppal K, Tubbs RS, Matusz P, Shaffer K, Loukas M. Meckel’s diverticulum: a review. Clin Anat. 2011;24:416–22.
Ruscher KA, Fisher JN, Hughes CD, Neff S, Lerer TJ, Hight DW, Bourque MD, Campbell BT. National trends in the surgical management of Meckel’s diverticulum. J Pediatr Surg. 2011;46:893–896.
Schoenwolf GC, Bleyl SB, Brauer PR, Francis-West PH. 2009. Larsen’s human embryology. 4th edn. Philadelphia: Churchill Livingstone. p. 15, 106, 128–162.
Malik AA, Shams-ul-Bari WKA, Khaja AR. Meckel’s diverticulum- revisited. Saudi J Gastroenterol. 2010;16:3–7.
Manning VR, McLaughlin EF. Persistent omphalomesenteric (vitelline) artery causing intestinal obstruction and gangrene of Meckel’s diverticulum. Ann Surg. 1947;126:358–65.
Haubrich WS, Schaffner F, Berk JE, editors. Gastroenterology. Philadelphia: Saunders; 1995. p. 12–4.
Giusti S, Iacconi C, Giusti P, Minuto M, Caramella D, Bartolozzi C. Ileal invaginated Meckel’s diverticulum: imaging diagnosis (2004:9b). Eur Radiol. 2004;14:2368–71.
Artigas V, Calabuig R, Badia F, Ruis X, Allende L, Jover J. Meckel’s diverticulum: value of ectopic tissue. Am J Surg. 1986;151:631–4.
Turgeon DK, Barnett JL. Meckel’s diverticulum. Am J Gastroenterol. 1990;85:777–81.
Madhyastha S, Prabhu VL, Saralaya V, Prakash. Meckel’s diverticulum: A case report. Int J Morphol. 2007;25:519–22.
Horgan EJ. Accessory pancreatic tissue. Arch Surg. 1921;2:521–34.
Ogata H, Takehito O, Hiroki I, Shuichi T, Minoru Y. Heterotopic pancreas in children: review of the literature and report of 12 cases. Pediatr Surg Int. 2008;24:271–5.
Williams RS. Management of Meckel’s diverticulum. Br J Surg. 1981;68:477–80.
Garretson DC, Frederich ME. Meckel’s diverticulum. Am Fam Physician. 1990;42:115–9.
DiGiacomo JC, Cottone FJ. Surgical treatment of Meckel’s diverticulum. South Med J. 1993;86:671–5.
Martin JP, Pamela DC, Kerri C. Meckel’s diverticulum. Am Fam Physician. 2000;61:1037–42.
Limas C, Konstantinos S, Anagnostoulis S. Axial torsion and gangrene of a giant Meckel’s diverticulum. J Gastrointest Liver Dis. 2006;15:67–8.
Segal SD, Albrecht DS, Belland KM, Elster EA. Rare mesenteric location of Meckel’s diverticulum, a forgotten entity: a case study aboard USS Kitty Hawk. Am Surg. 2004;70:985–8.
Jay GD III, Margulis RR, McGraw AB, Northrip RR. Meckel’s diverticulum; a survey of one hundred and three cases. Arch Surg. 1950;61:158–69.
Hollinshead WH. The jejunum, ileum and colon. In: Hollinshead WH, editor. Anatomy for surgeons, vol. 2. New York: Harper & Row; 1971. p. 478–86.
Manukyan MN, Kebudi A, Midi A. Mesenteric Meckel’s diverticulum: A case report. Acta Chir Belg. 2009;109:510–2.
De Boer NK, Kuyvenhoven JP. Rectal Meckel’s diverticulum. Endoscopy. 2009;41:E258.
Moore GP, Burkle FM. Isolated axial volvulus of a Meckel’s diverticulum. Am J Emerg Med. 1988;6:137–42.
Menezes M, Tareen F, Saeed A, Khan N, Puri P. Symptomatic Meckel’s diverticulum in children: a 16-year review. Pediatr Surg Int. 2008;24:575–7.
Hajivassiliou CA. Intestinal obstruction in neonatal/pediatric surgery. Semin Pediatr Surg. 2003;12(4):241–53.
Moore TC. Omphalomesenteric duct malformations. Semin Pediatr Surg. 1996;5:116–23.
Perlman JA, Hoover HC, Safer PK. Femoral hernia with strangulated Meckel’s diverticulum (Littre’s hernia). Am J Surg. 1980;139:286–9.
Brunicardi FC. 2005. Schwartz’s Principles of Surgery. 8th Ed. New York: McGraw-Hill. p 1043–1044. Stewart IC. 1985. Neurovascular hamartoma in a Meckel’s diverticulum. Br J Clin Pract 39:411–412.
Malhotra S, Roth DA, Gouge TH, Hofstetter SR, Sidhu G, Newman E. Gangrene of Meckel’s diverticulum secondary to axial torsion: a rare complication. Am J Gastroenterol. 1998;93:1373–5.
Sy ED, Shan YS, Yang YR, et al. Hirschsprung’s disease, a rare precipitating factor in neonatal perforated Meckel’s diverticulum. J Pediatr Surg. 2006;41:1319–21.
Mishalany HG, Pereyra R, Longerbeam JK. Littres hernia in infancy presenting as undescended testis. J Pediatr Surg. 1982;17(1):67–9.
Lee KH, Yeung CK, Tam YH, Ng WT, Yip KF. Laparoscopy for definitive diagnosis and treatment of gastrointestinal bleeding of obscure origin in children. J Pediatr Surg. 2000;35(9):1291–3.
Yau KK, Siu WT, Law BK, et al. Laparoscopy-assisted surgical management of obscure gastrointestinal bleeding secondary to Meckel’s diverticulum in a pediatric patient: case report and review of literature. Surg Laparosc Endosc Percutan Tech. 2005;15(6):374–7.
Murphy FJ, Mohee A, Khalil B, et al. Versatility of the circumumbilical incision in neonatal surgery. Pediatr Surg Int. 2009;25:145–7.
Scoutter AD, Askew AA. Transumbilical laparotomy in infants: a novel approach for a wide variety of surgical disease. J Pediatr Surg. 2003;38:950–2.
Suri M, Langer JC. A comparison of circumumbilical and transverse abdominal incisions for neonatal abdominal surgery. J Pediatr Surg. 2011;46:1076–80.
St-Vil D, Brandt ML, Panic S, Bensoussan AL, Blanchard H. Meckel’s diverticulum in children: a 20-year review. J Pediatr Surg. 1991;26(11):1289–92.
Yahchouchy EK, Marano AF, Etienne JF, Fingerhut AL. Meckel’s diverticulum. J Am Coll Surg. 2001;192(5):658–61.
Cooney DR, Duszynski DO, Camboa E, Karp MP, Jewett TC Jr. The abdominal technetium scan (a decade of experience). J Pediatr Surg. 1982;17(5):611–9.
Swaniker F, Soldes O, Hirschl RB. The utility of technetium 99 m pertechnetate scintigraphy in the evaluation of patients with Meckel’s diverticulum. J Pediatr Surg. 1999;34(5):760–5.
Poulsen KA, Qvist N. Sodium pertechnetate scintigraphy in detection of Meckel’s diverticulum: is it usable? Eur J Pediatr Surg. 2000;10:228–31.
Rerksuppaphol S, Hutson JM, Oliver MR. Ranitidine enhanced 99 m technetium pertechnetate imaging in children improves the sensitivity of identifying heterotopic gastric mucosa in Meckel’s diverticulum. Pediatr Surg Int. 2004;20:323–5.
Mackey WC, Dineen P. A fifty year experience with Meckel’s diverticulum. Surg Gynecol Obstet. 1983;156(1):56–64.
Peoples JB, Lichtenberger EJ, Dunn MM. Incidental Meckel’s diverticulectomy in adults. Surgery. 1995;118(4):649–52.
Michas CA, Cohen SE, Wolfman EF Jr. Meckel’s diverticulum: should it be excised incidentally at operation. Am J Surg. 1975;129(6):682–685.
Mukai M, Takamatsu H, Noguchi H, et al. Does the external appearance of a Meckel’s diverticulum assist in choice of the laparoscopic procedure? Pediatr Surg Int. 2002;18(4):231–3.
Kittle SF, Jenkins HP, Dragstedt LR. Patent omphalomesenteric duct and its relation to the diverticulum of Meckel. Arch Surg. 1947;54:10–36.
Cullen JJ, Keith K, Moir C, Hodge D, Zinsmeister A, Melton J. Surgical management of Meckel’s diverticulum. Ann Surg. 1994;220:564–9.
Rubin A. A handbook of congenital malformations. Philadelphia (Pa): Saunders; 2009.
Patel PJ, Kolawole TM, Izzidien Al-Samarrai AY. Vesicourachal diverticulum in association with other urological anomalies. Eur Urol. 1987;13(6):417–8.
Ueno T, Hashimoto H, Yokoyama H, Ito M, Kouda K, Kanamaru H. Urachal anomalies: ultrasonography and management. J Pediat Surg. 2003;38(8):1203–7.
McCollum MO, MacNeily AE, Blair GK. Surgical implications of urachal remnants: presentation and management. J Pediatr Surg. 2003;38:798–803.
Mesrobian HG, Zacharias A, Balcom AH, et al. Ten years of experience with isolated urachal anomalies in children. J Urol. 1997;158:1316–8.
Begg RC. The urachus: its anatomy, histology and development. J Anat. 1930;64:170–83.
Kluth D, Hillen M, Lambrecht W. The principles of normal and abnormal hindgut development. J Pediatr Surg. 1995;30:1143–7.
Parrot TS, Gray SW, Skandalakis JE. The bladder and urethra. In: Skandalakis JE, Gray SW, editors. Embryology for surgeons. 2nd ed. Philadelphia: Saunders.
Moore KL. The urogenital system. In: Moore KL, editor. The developing human. 3rd ed. Philadelphia: Saunders; 1982. p. 255–97.
Blichert-Toft M, Nielsen OV. Congenital patient urachus and acquired variants. Diagnosis and treatment. Review of the literature and report of five cases. Acta Chir Scand. 1971;137:807–14.
Gearhart JP, Jeffs RD. Urachal abnormalities. In: Walsh PC, Retik AB, Vaughan ED, et al., editors. Campbell’s urology, 7th ed. Philadelphia WB Saunders; 1998. p. 1984-1987.
Little DC, Shah SR, St. Peter SD, et al. Urachal anomalies in children: the vanishing relevance of the preoperative voiding cystourethrogram. J Pediatr Surg. 2005;40(12):1874–6.
Lane V. Congenital patent urachus associated with complete (hypospadiac) duplication of the urethra and solitary crossed renal ectopia. J Urol. 1982;127:990–2.
Rich RH, Hardy BE, Filler RM. Surgery for anomalies of the urachus. J Pediatr Surg. 1983;18:370–3.
Berman SM, Tolia BM, Laor E, et al. Urachal remnants in adults. Urology. 1988;31:17–21.
Schubert GE, Pavkovic MB, Bethke-Bedurftig BA. Tubular urachal remnants in adult bladders. J Urol. 1982;127:40–2.
Ozel LZ, Talu M, User Y, et al. Coexistence of a Meckel’s diverticulum and a urachal remnant. Clin Anat. 2005;18(8):609–12.
Cuda SP, Vanasupa BP, Sutherland RS. Nonoperative management of a patent urachus. Urology. 2005;66(6):1320.
Osawa K, Ito M, Sugiyama M, et al. A case of fetal vesicoallantoic cyst in the umbilical cord. Fetal Diagn Ther. 2003;18(2):87–90.
Yeats M, Pinch L. Patent urachus with bladder eversion. J Pediatr Surg. 2003;38:E56.
Dorai CRT. Umbilical evagination of the bladder with omphalocele minor. Pediatr Surg Int. 2000;16:128–9.
Lugo B, McNulty J, Emil S. Bladder prolapse through a patent urachus: fetal andneonatal features. J Pediatr Surg. 2006;41:E5–7.
Nobuhara KK, Lukish JR, Hartman GE, et al. The giant umbilical cord: an unusual presentation of a patent urachus. J Pediatr Surg. 2004;39(1):128–9.
Mata JA, Livne PM, Gibbons MD. Urinary ascites: complication of umbilical artery catheterization. Urology. 1987;30(4):375–7.
Rowe PC, Gearhart JP. Retraction of the umbilicus during voiding as an initial sign of a urachal anomaly. Pediatrics. 1993;91(1):153–4.
Ozbek SS, Pourbagher MA, Pourbagher A. Urachal remnants in asymptomatic children: gray-scale and color Doppler sonographic findings. J Clin Ultrasound. 2001;29(4):218–22.
Yu JS, Kim KW, Lee HJ, et al. Urachal remnant diseases: spectrum of CT and US findings. Radiographics. 2001;21(2):451–61.
Risher WH, Sardi A, Bolton J. Urachal abnormalities in adults: the Ochsner experience. South Med J. 1990;83(9):1036–9.
Avni EF, Matos C, Diard F, et al. Midline omphalovesical anomalies in children: contribution of ultrasound imaging. Urol Radiol. 1988;10(4):189–94.
MacNeily AE, Koleilat N, Kiruluta HG, et al. Urachal abscesses: protean manifestations, their recognition, and management. Urology. 1992;40(6):530–535.
Masuko T, Nakayama H, Aoki N, et al. Staged approach to the urachal cyst with infected omphalitis. Int Surg. 2006;91(1):52–6.
Minevich E, Wacksman J, Lewis AG, et al. The infected urachal cyst: primary excision versus a staged approach. J Urol. 1997;157(5):1869–72.
Cilento BG Jr, Bauer SB, Retik AB, et al. Urachal anomalies: defining the best diagnostic modality. Urology. 1998;52(1):120–2.
Fox JA, McGee SM, Routh JC, Granberg CF, Ashley RA, Hutcheson JC, Vandersteen DR, Reinberg YE, Kramer SA. Vesicoureteral reflux in children with urachal anomalies. J Pediatr Urol. 2011;7(6):632–5.
Cappele O, Sibert L, Descargues J, et al. A study of the anatomic features of the duct of the urachus. Surg Radiol Anat. 2001;23(4):229–35.
Pinthus JH, Haddad R, Trachtenberg J, et al. Population based survival data on urachal tumors. J Urol. 2006;175(6):2042–7. discussion 2047
Wright JL, Porter MP, Li CI, et al. Differences in survival among patients with urachal and nonurachal adenocarcinomas of the bladder. Cancer. 2006;107(4):721–8.
Rankin LF, Allen GD, Yuppa FR, et al. Carcinoma of the urachus in an adolescent: a case report. J Urol. 1993;150(5 Pt 1):1472–3.
Brick SH, Friedman AC, Pollack HM, et al. Urachal carcinoma. Radiology. 1988;169:377–81.
Beck AD, Gaudin JH, Bonhan GD. Carcinoma of the urachus. Br J Urol. 1970;42:555–62.
Mostofi FK. Potentialities of bladder epithelium. J Urol. 1954;71:705–14.
Cutting CW, Hindley RG, Poulsen J. Laparoscopic management of complicated urachal remnants. BJU Int. 2005;96(9):1417–21.
Peters CA. Laparoscopic and robotic approach to genitourinary anomalies in children. Urol Clin North Am. 2004;31(3):595–605.
Khurana S, Borzi PA. Laparoscopic management of complicated urachal disease in children. J Urol. 2002;168(4 Pt 1):1526–8.
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Sudhakaran, N., Okoye, B. (2018). Omphalomesenteric Duct and Urachal Remnants. In: Losty, P., Flake, A., Rintala, R., Hutson, J., lwai, N. (eds) Rickham's Neonatal Surgery. Springer, London. https://doi.org/10.1007/978-1-4471-4721-3_47
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