Congenital Umbilical Appendix Misdiagnosed as Umbilical Granuloma: Report of 2 Cases

Abstract

Background: Umbilical cord hernia is an uncommon umbilical anomaly which develops during 10th to 12th weeks of gestational age owing to failure of complete bowel return into coelomic cavity. In extremely rare cases appendix is the only trapped organ in hernia sac which may erode the overlying membrane and simulate umbili-cal granuloma.
 Case Report: Two infants presented with delayed umbilical cord separation with a reddish mass at umbilicus which was initially diagnosed as umbilical granuloma. Surgical exploration on failure of conservative measures revealed it as vermiform appendix. Appendectomy was done in both cases.
 Conclusion: Vermiform appendix at umbilicus is a rare congenital anomaly and may simulate other pathologies at umbilicus.

Umbilical Appendix Masquerading as a Patent Omphalomesenteric Duct in a Neonate

“…Since 1921, only 15 case reports of this entity have been published in the literature. Some of the cases have been associated either malrotation 6 or a mobile cecum 2,3,5,8,10,12–14 and a fistulous tract was identified in most of the cases (Table 1). Relative to the size of the neonate’s abdominal cavity, the cecum is relatively mobile.…”

“…Umbilical appendix is a rare condition with only 15 cases previously described in the literature to our knowledge (Table 1). [2][3][4][5][6][7][8][9][10][11][12][13][14] The infrequent nature of the condition makes it a difficult disease to study and its pathophysiology remains incompletely understood.…”

“…In rare cases, the appendix may be trapped in a hernia sac which may erode the overlying membrane and simulate umbilical granuloma. 2 In a recently reported paper by Ghourobi et al, both patients initially received medical treatment with the impression of an umbilical granuloma and the definitive diagnosis made at the time of surgery. 2 Recently, Guerron et al published a case of an appendicoumbilical fistula arising from a bifid appendix, which is an extremely rare clinical presentation.…”

“…2 In a recently reported paper by Ghourobi et al, both patients initially received medical treatment with the impression of an umbilical granuloma and the definitive diagnosis made at the time of surgery. 2 Recently, Guerron et al published a case of an appendicoumbilical fistula arising from a bifid appendix, which is an extremely rare clinical presentation. 3 Clinically, most infants may have a small amount of drainage, but significant or persistent drainage can signify an underlying abnormality.…”