UMBILICAL CONDITIONS IN THE ADUL T

UMBILICAL CONDITIONS IN THE ADUL T

Chronic infection in the umbilical area is common, particularly in patients with poor hygiene due to a plug of keratin causing chronic irritation. It is often encountered during elective Friedrich Trendelenburg , 1844–1924, Professor of Surgery , successively at Rostock (1875–1882), Bonn (1882–1895) and Leipzig (1895–1911), Germany . The Trendelenburg position was first described in 1885. Johann Frederick Meckel (the younger), 1781–1833, Professor of Anatomy and Surgery , Halle, Germany , described his diverticulum in 1809 although Littre , 1658–1726, surgeon and lecturer in anatomy , Paris, France, described Meckel’s diverticulum in a hernial sac in 1700, 81 years before Meckel was born. Sister Mary Joseph (nee Julia Dempsey ) , Nursing Superintendent, St Mary’s Hospital, Rochester, MN, USA, observed that patients with terminal cancer sometimes developed a red papular lesion in the umbilicus. She and William Mayo published this observation in 1928; however, it was Hamilton Bailey who coined the term ‘ Sister Mary Joseph’s nodule ’ in 1949. surgery and may complicate the insertion of a laparoscope port at the umbilicus. Occasionally , a rapid-onset, superficial cellulitis occurs even after minor surgery in this region. It is - normally due to a streptococcal infection and is treated with appropriate antibiotics. Pre-existing infection should be treated before surgery where possible. A chronic sinus may arise following umbilical hernia repair owing to infection of a mesh or non-absorbable suture material used. Antibiotics may help but usually the mesh or suture will need to be removed with a risk of recurrence of the her nia. In utero the umbilicus is connected to the gut by the vitellointestinal duct. In most patients the duct becomes totally - obliterated. The bowel end of the duct may persist as Meckel’s diverticulum. More rarely , the umbilical end persists, leading to chronic faeculent discharge. Rarely endometriosis can present with cyclical bleeding from the umbilicus. The urachus is a connection between the urinary bladder and umbilicus. It usually involutes but may present in later life as a r esult of increased pressure in the bladder usually due to prostatic hypertrophy . The cause of obstruction should be dealt with initially , but if the problem persists then surgical excision of the patent urachus might be considered. If tumour presents at the umbilicus it is most probably due to spread from the internal organs along internal ligaments, e.g. from the liver along the falciform ligament. A malignant mass at the umbilicus is called a Sister J oseph’s nodule. It usually indicates very advanced malignant disease and surgery probably has little to o ff er ( Figure 64.28 ). Malignancy at the umbilicus is rar e; however, primary squamous carcinoma may occur and malignancy may develop in a urachal remnant. Local excision is required. Alexis

Figure 64.28 Secondary nodule at the umbilicus: Sister Joseph’s nodule.