儿科脐部疾病（英文版）课件.ppt

Pediatric Umbilical Abnormalities Scott Nguyen MD Mount Sinai School of Medicine Dept of Surgery Abnormalities of Umbilical Cord Umbilical abnormalities result from failure of umbilical ring to close or persistence of umbilical structures Understanding embryology of cord is essential in understanding the pathophysiology of umbilical abnormalities Embryology - 3rd week Embryology Embrology Embryology 6th wk – midgut loop elongates and herniates out through umbilical cord Midgut rotates 270 degrees Returns to abdomen by 10th wk Anterior abdominal wall progressively closes leaving only umbilical ring Umbilical Abnormalities Urachal Abnormalities Vitelline Duct Abnormalities Umbilical Hernia Omphalitis Delayed Cord Separation Umbilical granuloma Urachal formation Bladder forms from ventral portion of cloaca Bladder descends into pelvis w/ urachus connecting apex to umbilicus Usually urachus involutes to a fibrous cord – median umbilical ligament Urachal abnormalities failure of obliteration of urachus resulting complete or partial patency of urachus 1/1000 live births inflammation or drainage from umbilicus US, CT, contrast studies, or injection of dye into tract can confirm diagnosis Patent Urachus Studies Catherization of tract and injection of dye Voiding cystourethrogram US Ultrasound CT VCUG Treatment Patent Urachus Patent Urachus Urachal Cyst Usually assx until infected Rarely become infected in newborn period, usu manifests as young adult Infected Urachal cyst Fever, voiding symptoms, midline hypogastric tenderness, mass, UTI May drain into bladder or umbilicus Rarely can rupture into preperitoneal tissues or peritoneal cavity Cultures - Staph Aureus US CT Infected Urachal cyst - treatment Incision and drainage Percutaneous drainage Complete surgical excision of all urachal tissue 30% recurrence if only drainage Staged approach limits amount of bladder resected Urachal Sinus Becomes symptomatic when infected Tx – drainage and resection of urachal tissu