Introduction !The umbilical polyp is a rare congenital lesion resulting from the persistence and outgrowth of omphalomesenteric duct (OMD) gastrointestinal mucosa which is retained in the umbilicus. Macroscopically the polyp resembles an umbilical granuloma which does not disappear after cauterisation with silver nitrate. The persistence of enteric mucosa leads to an intermittent discharge from the umbilicus that can be noticed in the first few days of life. The association of the umbilical polyp with other OMD remnants, including a patent vitelline duct to the bowel, sinus tract, vitelline duct cyst, Meckel's diverticulum, or obliterated duct (fibrous cord) is controversial. Some authors [8] have recommended exploration of the abdomen to exclude the presence of associated OMD anomalies but due to its rarity there are no large series reported in the literature that have clarified the need for abdominal cavity exploration in children with umbilical polyp. The aim of this study was to evaluate the need for peritoneal cavity exploration in a large series of children with umbilical polyp. Materials and Methods !Pathological specimens of all umbilical lesions excised between 1995 and 2005 in our institution were reviewed. Fifty-three patients were identified, 13 of whom had an umbilical polyp characterised histologically by the presence of gastrointestinal mucosa. The clinical notes of these 13 patients were reviewed and a long-term follow-up study was performed to investigate the presence of associated OMD anomalies. Abstract !Aim of the Study: The umbilical polyp is a rare congenital lesion resulting from the persistence of omphalomesenteric duct (OMD) enteric mucosa at the umbilicus. Exploration of the abdomen to exclude the presence of associated OMD remnants is controversial. The aim of this study was to evaluate the need for peritoneal cavity exploration in children with umbilical polyp. Methods: All umbilical lesions (n = 53) excised between 1995 and 2005 in a single institution were reviewed to identify patients with umbilical polyp (n = 13). This is characterised histologically by the presence of gastrointestinal mucosa. A follow-up study of patients with umbilical polyp was performed. Data are reported as median (range). Results and Conclusions: All 13 patients underwent excision of an umbilical polyp at a median age of 15.1 months (3.1 -80.5). All presented with a discharging polyp (associated with bleeding in 9) which did not respond to topical silver nitrate. Median diameter of the lesions was 0.5 cm (0.2 -1). Histology revealed the presence of small bowel mucosa in 11 (associated with pancreatic tissue in 1 and gastric mucosa in 1) and large bowel mucosa in 2. All patients underwent inspection and probing of the base of the polyp after its excision. In 6 patients an associated OMD anomaly was suspected and exploration of the peritoneal cavity was performed (mini-laparotomy in 5 and laparoscopy in 1). No OMD anomaly was found. The 7 children who did not undergo exploration of the abdominal cavity remain a...
Of 36 neonates with meconium ileus secondary to cystic fibrosis treated over a 10-year period, twenty-one (58%) had simple uncomplicated disease while fifteen (42%) had complications which included perforation (5), volvulus (6) and atresia (5). Gastrografin enema was employed in 20 infants with relief of obstruction in 8 (40%). Operative procedures consisted of resection and primary anastomosis in seventeen patients, stomas were fashioned in six, three had an enterotomy with irrigation only and two had Bishop-Koop enterostomy. Post-operative complications developed in 5 (18%) of these 28 patients. The overall survival rate was 97%. The one death occurred in an infant with short bowel syndrome, patent ductus arteriosus, hydrocephalus and pulmonary damage. There were eight additional patients who had meconium obstruction in the absence of cystic fibrosis.
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