Omphalolith: An underdiagnosed entity

Abstract

The umbilicus is a remaining scar in the center of the abdomen following the removal of the umbilical cord. 1 It has different shapes. Multiple affections can raise in this area including metastasis (Mary Joseph's nodule) and endometriosis. Less commonly reported yet benign conditions are important to diagnose. Omphalolith, also known as omphalokeratolith, omphalith, or umbolith, 2 is a rare and underdiagnosed entity due to the accumulation of sebum and keratin in the umbilicus. Omphalolith is derived from two Greek words: omphalos (navel) and lithos (stone). 3 It usually occurs in the elderly with deep and narrow umbilicus. Neglect and poor corporal hygiene represent the main risk factors. Early recognition of omphalolith is important to prevent unnecessary investigations and anxiety. Delayed diagnosis may lead to complications including irritation, erosions, bleeding, pyogenic granuloma, abscess formation, cellulitis, or even peritonitis. We report herein two new cases of omphalolith and provide a comprehensive summary of its characteristics. | CASE PRESENTATION | Case 1A 28-year-old female patient presented with a dark nodule on the umbilicus. She did not report pain, bleeding, discharge, or trauma and denied recent fever or weight loss. Past medical history was consistent with Wilson's disease with cirrhosis and hyperkinetic extrapyramidal symptoms. She was entirely dependent on her mother for daily activities. Clinical examination revealed a firm, keratotic, black nodule protruding out of the umbilicus, measuring 2 × 1 cm (Figure 1A). The surrounding skin was otherwise normal. Gentle traction of the nodule using dermal forceps allowed its extraction (Figure 1B).

Dermoscopy of Umbilical Lesions—A Systematic Review

“…The authors highlighted the fact that neither a pigment network, dots, globules nor a vascular pattern were present, what supported the differential diagnosis. In another dermoscopic case of omphalolith provided by Jouini et al [ 37 ] the presence of dry crusted pigmented lamellar keratotic material was reported.…”

“…The following supporting information can be downloaded at: , Table S1: Joanna Briggs Institute Appraisal tool questions; Table S2: Risk of bias assessment; Table S3: Overview of the characteristics of included studies. References [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ] are cited in the Supplementary Materials.…”