Weeping umbilicus

Weeping umbilicus in adult

Umbilical nodule

1.No umbilical discharge

1.1 Infection: infected umbilical cyst, umbilical dermatitis, omphalitis, pilonidal sinus-->I&D,excision

1.2 Non infection : granuloma, inclusion cyst, endometriosis, adenoma-->excision

: metastatic cancer-> search for primary cancer

2.Present with umbilical discharge

- Patent urachus, urachal cyst, sinus; uriine

- Patent omphalomesenteric duct ; feces - Umbilical endometriosis ; cyclical bood<

- Neoplastic ulceration from transverse coolon ; feces

Investigation: 1.fistulogram+- ultrasonography

2.CT scan

http://www.medassocthai.org/journal/files/Vol89_No.10_1753_4329.pdf

Metastatic cancer of umbilicus

Mary Joseph’s nodule usually represents metastatic cancers from gastrointestinal malignancy including adenocarcinoma of the pancreas

Sister Mary Joseph’s nodule usually presents as a painful lump with fibrotic consistency and irregular margins.

Differential diagnoses should include

- umbilical hernia,

- cutaneous endometriosis,

- benign tumors such as foreign body granuloma, melanocytic nevi, papilloma, fibroma and primary umbilical carcinoma including melanoma, squamous and basal cell carcinoma.

Since many benign conditions can mimic this umbilical metastasis, histological confirmation is always requisite before labeling these findings as umbilical metastasis.

Metastasis to the umbilicus is uncommon and represents only 10% of tumors which metastasize to the skin.

Gastrointestinal organs (35-65%), such as the stomach and the pancreas, are the most common sources of primary tumor which metastasize to the umbilicus (30%).

The most common primary site is the stomach in men and is the ovary in women.

Initially, it was speculated that embryologic remnants which connect to the umbilicus play an important role in the genesis of Sister Mary Joseph’s nodule. However, neoplastic cell propagation through lymph ducts and venous networks are also other important routes of umbilical metastasis . In addition, the contiguous extension of the malignant cells which form the primary site to the peritoneum and umbilicus were observed.

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Patent urachus report case in adult1: Hinyokika Kiyo. 2000 Jun;46(6):417-9.Links

A case of patent urachus in an adult male

**Katoh N**, **Furuta N**, **Kishimoto K**, **Madarame J**, **Kazuhiro** , **Hasegawa AT**,**Onodera S**, **Ohishi Y**.

Department of Urology, Jikei University School of Medicine.

A 31-year-old man was referred to our hospital for evaluation of urachal rest. The history of his present illness dated back to birth, when the umbilicus was projected and urinary discharge was noted. At that time, the symptom of discharge had spontaneously subsided. At the age of 22, however, the patient again experienced discharge from the umbilicus. Although he did not seek treatment, after six years this symptom disappeared. Around this time, however, pyuria was revealed during medical examination, and abdominal ultrasonography (US) suggested the presence of urachal rest. At the time of hospitalization, physical examination revealed that the patient's right testis was not palpable. He was diagnosed with patent urachus with hemilateral aplasia and monorchism by US, computed tomography, magnetic resonance imaging and cystoscopy. The patient subsequently underwent radical operation. Patent urachus in adults is very rare, and only a few cases have been reported. To our knowledge, only one previously reported case involved a recurrence after spontaneous healing. Further, this is the first report of a patient with patent urachus with hemilateral aplasia and monorchism. Radical operation is generally recommended, based on the fact that very few cases heal conservatively.

PMID: 10934613 [PubMed - indexed for MEDLINE]

1: Int J Urol. 1994 Sep;1(3):275-7.Links

Congenital patent urachus in an adult: a case report.

**Takano Y**, **Okatani K**, **Okamoto S**, **Enoki N**.

Department of Urology, Okatani Hospital, Nara, Japan.

A rare case of the congenital patent urachus in an adult is reported. The patient, a 42-year-old man, was admitted with the chief complaint of macroscopic hematuria. During the cystoscopy perfusion water discharged from the umbilicus. Diagnostic imaging revealed a tubular fistula between the bladder and umbilicus and the patient underwent urachal resection and partial cystectomy. Microscopically the lumen was lined by transitional, columnar and squamous epithelium and there was no evidence of malignancy. To date 11 cases of congenital patent urachus in an adult have been reported in Japan. From a review of the Japanese literature, the common chief complaint is urine discharge from the umbilicus accompanying cystitis and/or urachal inflammation. Urachal resection is performed in all cases. We also clarified the epithelial histology of the patent urachus in this patient.

PMID: 7614387 [PubMed - indexed for MEDLINE]

1: Urology. 1998 Jul;52(1):120-2.Urachal anomalies: defining the best diagnostic modality. 3 tools for diagnosis: Hx&PE, mass-U/S, sinus drainage - sinogram, A combination of ultrasound and fistulography is essential to confirm the diagnosis.

VCUG-ไม่ค่อยช่วยเลย is not warranted