Umbilical Polyp (UP)

  • Mohamed Fahmy
Chapter

Abstract

The most frequent umbilical mass in neonates is the umbilical granuloma followed by the umbilical polyp; most of UP are congenital, and few entities are an acquired lesions, but we opted to discuss this pathology with the acquired lesions because of the resemblance between UP and U granuloma and to give some clues for differentiation between those different pathologies, with some shared features. After cord stump separation, the umbilical scar covered by a normal skin, any abnormal mucosal overgrowth at the umbilical base, which may result in a polypoid mass; most of literatures are describing only one type of UP, which is a remnant of the omphalomesenteric duct, but herein all possible types of UP will be classified and described. These polyps are rare abnormalities and are usually diagnosed in neonates, especially the congenital one, although lesions have been found in older children and also in adults, but in the latter they are exceptional, and it is usually neoplastic, and of course it is an acquired lesion, with a wide spectrum of different pathologies. Clinically UP presents as a small round swelling, with red, smooth surface and shiny appearance because it is mucosa, covered with serosity and located at the base of the umbilicus. Differential diagnosis of this polyp may pose difficulties, especially with umbilical granuloma because of its clinical similarity; with a more frequent presentation, granuloma is mainly distinguished by its smaller size and the good response that it presents to topical treatment, whereas in the polyp the treatment is surgical. Other entities to be differentiate from UP are persistence of urachus, omphalocele, haemangiomas and keloid umbilical scar. In UP the histopathological study of the lesion shows an abrupt transition from squamous epithelium to an intestinal, colonic or gastric glandular epithelium and less frequently pancreatic tissue. In adults, metastases from intra-abdominal tumors need to be excluded. Diagnosis of UP is usually made by physical exam, which may demonstrate a watery discharge from the umbilicus, imaging, including ultrasound, computerized tomography, fistulogram or voiding cystourethrography, which could also be useful in the diagnosis of patent urachus. Surgical excision of UP is mandatory with or without abdominal exploration to detect any other associated anomalies.

Keywords

Polyp Omphalomesenteric duct Meckel’s diverticulum Fibrous umbilical polyp Ectopic mucosa 

References

  1. 1.
    Sánchez-Castellanos M, Sandoval-Tress C, Hernández-Torres M. Persistencia del conducto onfalomesentérico: Diagnóstico diferencial de granuloma umbilical en la infancia. Actas Dermosifiliogr. 2006;97:404–5.CrossRefPubMedGoogle Scholar
  2. 2.
    Fitz R. Persistent omphalomesenteric remains, their importance in the causation of intestinal duplication, cyst formation, and obstruction. Am J Med Sci. 1884;88(175):30–57.CrossRefGoogle Scholar
  3. 3.
    Aitken J. Remnants of the vitellointestinal duct a clinical analysis of 88 cases. Arch Dis Child. 1953;28(137):1–7.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Kittle CF, Jenkins HP, Dragstedt LR. Patent omphalomesenteric duct and its relation to diverticulum of Meckel. Arch Surg. 1947;54:10–36.CrossRefPubMedGoogle Scholar
  5. 5.
    Heatly MK, Mirakhur M. Cutaneous remnants of the vitellointestinal duct: a clinic-pathological study of 19 cases. Ulster Med J. 1988;57(2):181–3.Google Scholar
  6. 6.
    Storms P, Pexters J, Vandekerkhof J. Small omphalocele with ileal prolapse through patent omphalomesenteric duct a case report and review of literature. Acta Chil Belg. 1988;88:392–4.Google Scholar
  7. 7.
    Taranath A, Lam A. Ultrasonographic demonstration of a type 1 omphalomesenteric duct remnant. Acta Readiol. 2006;47:100–2.CrossRefGoogle Scholar
  8. 8.
    Thomson JE. Perforated peptic ulcer in Meckel's diverticulum. Ann Surg. 1937;105:44.CrossRefGoogle Scholar
  9. 9.
    Steck WD, Helwig EB. Cutaneous remnant of the omphalomesenteric duct. Arch Dermatol. 1964;90:463–70.CrossRefPubMedGoogle Scholar
  10. 10.
    Kutin ND, Allen JE, Jewett TC. The umbilical polyp. J Pediatr Surg. 1979;14(6):741–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Pacilli M, Sebire NJ, Maritsi D, Kiely EM, Drake DP, Curry J, Pierro A. Umbilical polyp in infants and children. Eur J Pediatr Surg. 2007;17(6):397–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Jessica W, Hsu BS, Wynnis L. Tom: omphalomesenteric duct remnants: umbilical versus umbilical cord lesions. Pediatr Dermatol. 2011;28(4):404–7.CrossRefGoogle Scholar
  13. 13.
    Oğuzkurt P, Kotiloğlu E, Tanyel FC, Hiçsönmez A. Umbilical polyp originating from urachal remnants. Turk J Pediatr. 1996;38(3):371–4.PubMedGoogle Scholar
  14. 14.
    Bambirra EA, Miranda D. Gastric polyp of the umbilicus in an 8-year-old boy. Clin Pediatr. 1980;19(6):430–2. doi: 10.1177/000992288001900609.CrossRefGoogle Scholar
  15. 15.
    Iwasaki M, Taira K, Kobayashi H, Saiga T. Umbilical cyst containing ectopic gastric mucosa originating from an omphalomesenteric duct remnant. J Pediatr Surg. 2009;44:2399–401.CrossRefPubMedGoogle Scholar
  16. 16.
    Cevik M, Boleken ME, Kadıoglu E. Appendicoumbilical fistula: a rare reason for neonatal umbilical mass. Case Rep Med. 2011;2011:2. doi: 10.1155/2011/835474W.T.CrossRefGoogle Scholar
  17. 17.
    Lee WT, Tseng HI, Lin JY, et al. Ectopic pancreatic tissue presenting as an umbilical mass in a newborn: a case report. Kaohsiung J Med Sci. 2005;21(2):84–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Vargas SO. Fibrous umbilical polyp: a distinct fasciitis-like proliferation of early childhood with a marked male predominance. Am J Surg Pathol. 2001;25:1438–42.CrossRefPubMedGoogle Scholar
  19. 19.
    Ford T, Widgerow AD. Umbilical keloid: an early start. Ann Plast Surg. 1990;25:214–5.CrossRefPubMedGoogle Scholar
  20. 20.
    Stock N, et al. Umbilical polyp in an infant. Pediatr Dev Pathol. 2008;11:165–6. doi: 10.2350/07-09-0342.1.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Mohamed Fahmy
    • 1
  1. 1.Pediatric SurgeryAl Azher University Pediatric SurgeryCairoEgypt

Personalised recommendations