A Study of Symptomatic Umbilical Remnants in Children with Evaluation of the Role of Ultrasound as a Diagnostic Modality.

AIMS

The aim of this study was to study the presentation and management of children with symptomatic "umbilical remnants" (SUmR) and the efficacy of ultrasound (US) in diagnosis and predicting a need for surgery.

MATERIALS AND METHODS

This study included 65 children aged 2 months-12 years with clinical findings suggestive of umbilical remnants (UmR): umbilical granuloma (UG); umbilical polyp or prolapsing mucosa, periumbilical inflammation/mass, or persistent umbilical discharge. Investigations included US and bacteriological culture-sensitivity tests of umbilical discharge. UG and umbilical polyps were excised. Minilaparotomy was performed for other SUmR and UG/umbilical polyps where US suggested intra-abdominal pathology. The excised UmR tissue underwent histopathologic examination (HPE) for final diagnosis.

RESULTS

There were 40 males and 25 females, with a median age of 6 months. The three groups after final diagnosis were (i) UG ( = 38), (ii) vitellointestinal (VI) remnants ( = 21), umbilical polyp ( = 17), patent VI duct (PVID) ( = 3), and umbilical cyst ( = 1), and (iii) urachal remnants (UR) ( = 6), urachal cysts ( = 3) and patent urachus ( = 3). Forty-nine UG/umbilical polyps underwent simple excision. Sixteen (24.6%) patients underwent minilaparotomy, and in seven, US findings correlated with operative findings. US was false positive for intra-abdominal pathology in six cases (UG = 3; umbilical polyp = 3) and false negative in PVID ( = 3). UG and umbilical polyps were differentiated only by HPE. There were no complications or recurrence. On grouping by presentation, US as a diagnostic modality in UG/umbilical polyp had a specificity of 85% with a diagnostic accuracy of 89.09%. In UR, the figures were sensitivity 100%, specificity 0%, positive predictive value (PPV) 100%, negative predictive value (NPV) 0%, and diagnostic accuracy 100%. For VID remnants excluding umbilical polyps, the sensitivity was 25%, specificity 0%, PPV 100%, NPV 0%, and diagnostic accuracy 25%. Overall, the sensitivity of abdominopelvic US as a diagnostic modality in SUmR was 70%, specificity 89%, PPV 53%, and NPV 94% with overall diagnostic accuracy of 84%.

CONCLUSIONS

SUmR is most commonly UG or umbilical polyp and could not be differentiated on clinical grounds alone. In suspected urachal anomalies/UR, US is an effective diagnostic modality. Overall, however, US has relatively low sensitivity and a low PPV and should be regarded as an accessory rather than a very effective diagnostic modality in SUmR. One-stage excision of SUmR is safe and effective. HPE of the excised SUmR is essential for the final diagnosis.