Umbilical Granuloma Research Articles

Comparison between silver nitrate and table salt in the treatment of umbilical granuloma.

Objective: To compare the efficacy of table salt with silver nitrate in the treatment of umbilical granuloma presenting to the neonatal unit/paediatric department KTH. Study Design: Randomized Controlled Trial Setting: Neonatal Unit of Khyber Teaching Hospital. Period: November 2019 to November 2022. Methods: A total of 120 patients who presented to the neonatal unit/paediatric department, aged 15-60 days were enrolled in this study via consecutive sampling. Seventy-five patients each, were allocated to two groups, Group A (common salt) and Group B (silver nitrate). Sixteen patients from Group A whereas, in Group B, 17 patients were lost to follow-up. Results: A total of 58 out of the remaining 117 patients were female whereas 59 patients were male. Treatment response was recorded for both groups. The cure rate was greater among Group B (93%) as compared to Group A (88%) but there was no statistically significant difference between Group A and B in treatment response (p= 0.35). Conclusion: Table salt is a cheaper, easily accessible, and safe alternative to topical silver nitrate in the treatment of umbilical granuloma.

Common Salt versus Silver Nitrate for the Treatment of Umbilical Granuloma in Infants: An Open-label, Single-center, Pilot Randomized Controlled Trial.

This study aims to compare the efficacy and safety of topical application of common salt (CS) in comparison to silver nitrate (SN) for treating infants with umbilical granuloma (UG). We conducted an open-label, prospective, single-center, pilot randomized controlled trial. Thirty-seven infants with a clinical UG diagnosis were enrolled between October 2022 and July 2023, excluding those previously treated for UG. Patients were randomly assigned (using the Randomizer® app) to receive either topical CS (applied thrice daily by caregivers at home for 5 days) or SN (applied by pediatric surgeon in clinic and kept under occlusive dressing for 48 h). Patients with partial/no healing received an additional session of the same treatment. Nonresponders transitioned from CS to SN, and vice versa, for two more applications. Healing rates were compared with a significance level of α =0.05. Out of 34 patients (18 CS and 16 SN), 32 successfully completed the trial (17 CS and 15 SN). No significant differences were observed in baseline characteristics. Efficacy rates of CS (19/22; 86.36%) and SN (11/17; 64.71%) did not significantly differ (P = 0.056; 95% confidence interval [CI] -0.4832-0.0502). No major adverse events were reported. CS showed superior healing outcomes in infants below 3 months of age (19/22; 86.36%) compared to SN (11/17; 64.71%) (P = 0.056; 95% CI - 0.4832-0.0502). The timing of umbilical cord detachment did not significantly affect healing rates. Widespread availability, ease of access, suitability for safe home application, and cost-effectiveness make CS a primary treatment option for UG. Larger patient cohorts are needed for conclusive results.

Successful Management of the Omphalomesenteric Fistula: About Three Case Reports

The omphalomesenteric duct is an embryologic connection between the midgut and yolk sac, which typically disappears at the 5th to 7th week of gestation. Failure of the obliteration process can lead to omphalomesenteric duct remnants. It usually has a difficult diagnosis, manifested by a variety of cutaneous signs, such as an umbilical mass, granulation tissue, or discharge. This article reports three cases of total persistence of the OMD and reviews the surgical management of those lesions. The first case reports a 6-day-old boy with a patent omphalomesenteric duct fistula opening to the umbilicus presenting with feces sprouting from the umbilical stump. The second one reports a one-month-old infant brought to the hospital with umbilical granuloma, with no response to topical treatment that later started draining feces from the umbilical cord. The third one reports a three-day-old male newborn that manifested a granuloma-like lesion on the umbilical scar with no improvement with topical treatment. A simple catheterization with a relation catheter was performed in all cases showing drainage of a bilious secretion. they were then diagnosed with a persistence of the Vitelline Duct. All infants had a similar surgical approach, with an abdominal elective incision made around the lesion on the abdominal wall. Identification of the fistula trajectory, followed by resection of the bowel segment that contains the fistulae and a formation of a terminal-terminal anastomosis.

Persistence of Urachus in A 7-Month-Old Male Patient with Surgical Resolution: Case Report

Introduction: Patent urachus refers to a rare condition called urachus anomaly. These conditions are caused by the failure of the normal fetal tissue used to empty the fetal bladder to degenerate. Some of these urachal abnormalities are obvious at birth, while others are more subtle and are not diagnosed until adulthood or are discovered only incidentally after imaging for other reasons. Urachal anomalies in children with wet umbilical cord, persistent drainage, recurrent urinary tract infections, and recurrent umbilical cord infections require accurate and timely diagnosis to help relieve symptoms, prevent recurrent serious infections, and ensure timely treatment. Clinical case: The case of a 7-month-old male patient is presented. The mother reports umbilical granuloma of several months of evolution. He goes to a doctor where he suggests an ultrasound examination that rules out persistence of urachus. Mass in umbilical region persists, which is why she comes again. Evolution: By laparoscopic vision, umbilical hernia plus persistence of urachus is evident, findings such as the presence of indirect bilateral inguinal hernia are found. After surgery, the patient recovered satisfactorily. Conclusions: Diagnosis of urachal anomalies can be elusive, but continued drainage of the umbilical cord is a concern in the case of urachal anomalies. Although this condition is usually an isolated finding, the possibility of posterior urethral valves in infants with a patent urachus should not be ruled out.

Establishing a safe pediatric surgery day unit: Process, procedures, and performance

Abstract Background: Ambulatory surgery for babies and infants is commonly practiced worldwide. There are no reports on this special service from the UAE. A Pediatric Surgery Day Unit (PSDU) has been in operation at Danat Al Emarat Hospital Women and Children since the hospital opened in 2016. Objective: To describe the day-to-day structure and functioning of the PSDU, the technical aspects of the four main procedures delivered (Circumcision, Release of Tongue Tie, Excision of Umbilical Granuloma, and Excision of Accessory Digits) and the outcomes for the babies. Materials and Methods: The hospital’s Health Information System was interrogated for the relevant diagnostic and procedural codes for all babies operated between January 1st, 2016, and December 31st, 2019. Data were analyzed for basic demographics, biostatistics, procedures performed, and follow-up encounters. Results: The PSDU has a core team, including a coordinator/scheduler, one practical nurse, two staff nurses, and two surgeons. Up to 10 sessions are offered per week, and out-of-hours cover is provided for emergencies or advice on a 24/7 basis. A total of 5262 medical records were examined and data on 3891 procedures for 3801 babies were analyzed. Babies of 68 nationalities were operated and 65% were local Emirati. Circumcision was performed at a median age of 16 days and a weight of 3.5 kg. Bleeding occurred in 1.4% and retention of the ring occurred in 1%. Significant factors associated with bleeding are age, weight, and ring size. There is no difference in bleeding rates between surgeons. There is a learning curve for the technique. Retention of the ring on the glans is associated with the size of ring chosen and retention rates vary significantly between surgeons. The remaining procedures were performed without complication, giving an overall adverse event rate of 2.75%. Conclusion: A well-structured and consistently staffed PSDU results in a safe and effective service.

Pediatric Gastrointestinal Obstruction Due to Umbilical Granuloma and Meckles Diverticulum: A Surgical Insight

Pediatric Gastrointestinal Obstruction Due to Umbilical Granuloma and Meckles Diverticulum: A Surgical Insight

Interventions for treating umbilical granuloma: a protocol for a systematic review and meta-analysis of randomised controlled trials

IntroductionThe most frequent umbilical abnormality in infancy period is umbilical granuloma. Although umbilical granuloma treatment with silver nitrate is practised worldwide, silver nitrate cauterisation is high in cost and if...

Umbilical Granuloma: A case report

After birth, remnants of the umbilical cord should separate spontaneously from the neonate within 1-2 weeks. However, in certain instances, following separation, a small red or pink moist bump forms in a neonate’s umbilical stump known as an umbilical granuloma. Treatment options include the application of silver nitrate, salt application, double-ligature technique, cryosurgery, and surgical excision. We present a 7 week old male with an umbilical granuloma treated with the double ligature technique using an absorbable suture with the disappearance of the lesion at a 1 week follow up visit. The ligature technique is one of several methods used in the treatment of umbilical granuloma. Although non-absorbable silk sutures are commonly used for this technique, absorbable sutures can be used for lesions with a narrow stalk.

Umbilical Granuloma: Frequency, Associated Factors, 10-Year Treatment Trends, and Effectiveness at a Single Hospital in Japan.

Umbilical granuloma (UG) is a common problem during the neonatal period; however, its epidemiology and etiology are poorly studied, and the best treatment option has not yet been established. We examined the medical records of neonates who were born and underwent 1-month evaluations at our hospital between 2013 and 2022 to investigate the frequency of-and factors associated with-UG, as well as the annual trends of UG treatments and their efficacy. Of the 6680 eligible neonates, 395 (5.9%) had UG. The annual incidence rate ranged from 3.8% to 7.3%. Gestational age, birth weight, and incidence of meconium-stained amniotic fluid were significantly associated with UG. Silver nitrate cauterization was the predominant UG treatment from 2013 to 2016. Silver nitrate cauterization and topical betamethasone valerate were nearly equally applied in 2017. Betamethasone application became predominant in 2018. The healing rates during the initial treatment period were 91% for silver nitrate cauterization, 97.7% for betamethasone application, 60% for ethanol disinfection, and 88% for ligation; these rates were significantly different (p < 0.001). Topical steroid application may be the most effective treatment. If steroid application is ineffective, then silver nitrate cauterization and ligation may be important treatment options.

Efficacy Of Common Salt Application On The Umbilical Granuloma In Infants.

The objective of this study was to determine the efficacy of the application of common plain salt for the treatment of umbilical granuloma in infants. The study design was descriptive case series and was conducted over a period of 12 months at the paediatric unit, Mardan Medical Complex, Mardan, Pakistan. For this study a total of 50 infants with clinically evident umbilical granuloma were selected. Application of a pinch of common plain salt was advised on the granuloma twice a day for three consecutive days. Outcomes in the shape of complete resolution of the granuloma, adverse effects, and recurrence of granuloma were assessed. The number of patients responding well to the treatment was 45 (90%). The treatment showed good response and there was not any adverse effect or recurrence. It was concluded that the common plain salt is a simple, effective, safe, and cheaper option for the treatment of umbilical granuloma in infants.

Silver nitrate burns following umbilical granuloma treatment

Silver nitrate burns following umbilical granuloma treatment

Heterotopic gastric mucosa of the umbilicus

Abstract Umbilical discharge is a commonly encountered problem in infants, with common causes being omphalitis and umbilical granuloma. Unusual causes of persistent umbilical discharge are remnants of the omphalomesenteric duct and the urachus. Heterotopic or ectopic tissues at the umbilicus are rare events that cause umbilical discharge and these mandate a surgical intervention. Gastric heterotopia at the umbilical region is such an unusual entity causing persistent discharge and chemical dermatitis around the region, which needs surgical intervention. We hereby report a rare case of gastric heterotopia of the umbilicus in an 8-month-old male baby.

A Novel Strategy for Umbilical Granuloma Removal: Cutting off with a Nylon Suture Thread

Umbilical granuloma is a common umbilical problem in infants. Although various modalities are available for the treatment of umbilical granulomas, the best method remains controversial. A 7-week-old infant presented with umbilical granuloma followed by omphalitis. We treated the omphalitis first to prevent local inflammation. On the following day, the umbilical granuloma was successfully cut off with a nylon suture thread. No residue of the granuloma was left behind and no signs of local inflammation appeared. Umbilical granuloma can be successfully removed with a nylon suture thread. Treatment for omphalitis before granuloma removal may be useful to prevent local inflammation.

Effective home treatment of umbilical granuloma using table salt in African children

Introduction: Following the adoption of home based, table salt treatment for Umbilical granuloma in our practice, we observed that there was a paucity of report on the use of table salt for the treatment of Umbilical granuloma in African children. We report the outcome of treatment of eight children treated with Table salt in our facility.&#x0D; Methods: We carried out a retrospective review of the medical records of infants who were diagnosed with umbilical granuloma and were managed using table salt in our hospital in 2016 and 2020. Additional data about diagnosis, treatment and outcome were extracted from records of electronic communications via emails and WhatsApp® between the Paediatrician and caregivers of these infants. Written informed consent of caregivers of the infants were obtained and the study received approval of the Research and Ethics Committee of our Hospital.&#x0D; Results: Nine infants were diagnosed with Umbilical granuloma during the study period but informed consent was obtained for eight of them. All eight children (100%) treated with table salt had resolution of umbilical granuloma confirmed at the end of the treatment period without any adverse event.&#x0D; Conclusion: Home based, Table salt treatment was found to be safe and effective treatment for umbilical granulomas among the children treated in our facility.

Spontaneous Umbilical Endometriosis: A Case Report

Endometriosis is a common gynecological entity that usually occurs in the pelvic organs. Umbilical endometriosis is a rare condition that accounts for 0.5-1% of all extragenital endometriosis. It usually arises secondary to prior surgery but may arise de novo as well. We report a case of this condition with the spontaneous occurrence, which was diagnosed preoperatively as umbilical granuloma. Umbilical endometriosis should be kept in differential diagnoses in women with umbilical lesions.

Effective home treatment of umbilical granuloma using table salt in African children

Introduction: Following the adoption of home based, table salt treatment for Umbilical granuloma in our practice, we observed that there was a paucity of report on the use of table salt for the treatment of Umbilical granuloma in African children. We report the outcome of treatment of eight children treated with Table salt in our facility.&#x0D; Methods: We carried out a retrospective review of the medical records of infants who were diagnosed with umbilical granuloma and were managed using table salt in our hospital in 2019 and 2020. Additional data about diagnosis, treatment and outcome were extracted from records of electronic communications via emails and WhatsApp® between the Paediatrician and caregivers of these infants. Written informed consent of caregivers of the infants were obtained and the study received approval of the Research and Ethics Committee of our Hospital.&#x0D; Results: Nine infants were diagnosed with Umbilical granuloma during the study period but informed consent was obtained for eight of them. All eight children (100%) treated with table salt had resolution of umbilical granuloma confirmed at the end of the treatment period without any adverse event.&#x0D; Conclusion: Home based, Table salt treatment was found to be safe and effective treatment for umbilical granulomas among the children treated in our facility.

Umbilical granuloma frequency of newborns in Third-line Hospital in Turkey.

The aim is to determine the umbilical granuloma frequency of newborns and etiological factors. In this study, the records of 21344 newborns who were admitted to our hospital between February 2015 and August 2019, were examined. 21191 newborns are included in the study. 2.4% of newborns was Syrian refugee and others were citizens of Turkey. Umbilical granuloma frequency was % 3.83. While umbilical granuloma frequency was 3.85% in Turkish citizen newborns, %3.01 in Syrians. Mean umbilical cord seperation time was 7.1 days in cases with umbilical granuloma. There was no statistically significant relationship determined between umbilical granuloma development and race and time of umbilical cord seperation (p >0.05) The frequency of umbilical granuloma was 3.5% for boys and 4.1% for girls. Umbilical granuloma was being observed statistically significantly higher in girls than in boys (p <0.05). 80.8% of the cases with umbilical granuloma were bathed before the umbilical cord seperation. A significant difference was determined between bathing before umbilical cord seperation and umbilical granuloma development (p < 0.05). Umbilical granuloma, with frequency of 3.83% in newborns. Umbilical granuloma is more common in girls and newborns bathed before the umbilical cord seperation.

Persistent umbilical polyp in a 5-year-old boy – A rare case report with literature review

Umbilical granulomas are rare lesions that result due to incomplete closure of the omphalomesenteric duct at the umbilicus. We are presenting a case of umbilical polyp which has persisted in a 5-year-old male child.

Umbilical Discharge

An umbilical discharge is itself not a disease, but it is a symptom of many diseases. In children, it may be found to be associated with an underlying congenital abnormality like persistent OMD (Omphalo-mesenteric Duct) or Vitelline cysts or sinuses or umbilical granuloma or a diverticulum like the Meckel’s diverticulum which may possess ectopic gastric or pancreatic or even colonic mucosa, or the persistent allantois or a urachal cyst or an infected urachus etc. Umbilical discharge though rare in adults, it may be caused by diverse congenital or acquired conditions. The most common causes of umbilical discharge in adults are such acquired conditions as pilonidal sinus disease, infection of hair tufts and foreign bodies4, and specific and non-specific acute and chronic inflammation and abscess of the umbilicus, infected omphalolith etc. Very rarely the discharge may be due to endometriosis or metastatic carcinoma, umbilical hernia ulceration etc. Discharging umbilical abscess may be caused by bacteria that can enter as a result of penetrating trauma, rupture of the bowel, or abdominal surgery. Irrespective of aetiology, umbilical discharge is a distressing condition for the patient and the family members. Appropriate diagnostic aids and successful management strategies are now available. If not associated with malignant diseases or irreversible complications, the prognosis is excellent. KYAMC Journal Vol. 13, No. 01, April 2022: 50-55

Randomised comparative study on the efficacy of 3% versus 30% NaCl solution in the treatment of umbilical granuloma.

This study aimed to compare the efficacy of 3% versus 30% NaCl solution in treating umbilical granuloma (UG) and to evaluate parental satisfaction. A randomised, double-blinded, comparative study in neonates with UG was conducted. Stratified, block-of-four randomisation was used to allocate neonates into two groups, treated with 3% or 30% pharmaceutical-grade NaCl solution, three times daily. The time to resolution was determined by daily photographs of UG and weekly hospital visits. If there was no response after 2 weeks, silver nitrate was used. Parental satisfaction was measured on a rating scale of 1-5. One hundred neonates were enrolled, 48 in the 3% NaCl group and 52 in the 30% NaCl group. Baseline demographic data were not different between the groups. There was no significant difference in the resolution rate (93.8% vs 98.1%) or the median (interquartile range) time to resolution (7 (5-13) vs 7 (4-11) days) between the 3% and 30% NaCl groups, respectively. No skin burn or cellulitis was detected. About 95% of parents scored >4 for satisfaction. Hypertonic NaCl solution is highly effective in treating UG without side effects. Hypertonic NaCl solution should be considered as an alternative treatment for UG.