Pictorial case study: umbilical granuloma

The case  

A baby was brought by her mother for her routine six-week check. She was well and thriving. Examination was normal except that on abdominal examination there was an obvious pouting umbilicus surmounted by a bright red, moist, glistening, friable mass. The baby seemed unaffected by this and palpation did not seem to cause her any discomfort. What is the diagnosis, management and differential diagnoses?  

Diagnosis and management  

This is an umbilical granuloma. Usually after the umbilical cord has been cut and tied, the remnant shrivels and falls off. The chronic inflammation at the line of demarcation is quickly covered in normal circumstances by epithelium, but if this does not occur excess granulation tissue can form. This is often due to infection. The condition is painless but may cause parents alarm especially if the granulation area is large. It may occasionally bleed if traumatised.  

Treatment is reassurance that the condition is painless. The granulation may be treated either with silver nitrate applications or with salt. Sometimes more than one application is required. There is discussion that silver nitrate may cause trauma.  

Possible different diagnosis  

  • Umbilical hernia.  
  • Patent urachus.  

Differential diagnosis  

Umbilical hernia  

  • Common in premature babies and those of black ethnic origin.  
  • Protrusion of bowel through weaker section of abdominal wall.  
  • It usually closes by the time the infant is four years of age.  
  • Requires surgical correction if larger than 2cm.   

Contributed by Dr Gwen Lewis, a GP in Windsor, Berkshire

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