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Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e3182491483
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Appendicoumbilical Fistula: Cause of an Umbilical Mass With Drainage

Montes-Tapia, Fernando; Garza-Luna, Ulises; Cura-Esquivel, Idalia; Gaytan-Saracho, Diego; de la O-Cavazos, Manuel

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Department of Pediatrics, “Dr Jose E. Gonzalez” University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico.

Address correspondence and reprint requests to Dr Fernando Montes-Tapia, Associate Professor of Pediatrics and Surgery, Department of Pediatrics, “Dr Jose E. Gonzalez” University Hospital, Universidad Autonoma de Nuevo Leon, Madero y Gonzalitos s/n, Monterrey, Nuevo Leon 64460, Mexico (e-mail: fernando.montestp@uanl.edu.mx).

Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images. Submissions are to be made online at www.jpgn.org, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as by the Journal.

The authors report no conflicts of interest.

A 2-month-old boy was referred with an umbilical granuloma treated with silver nitrate without involution. A firm red mass 1.3 × 0.5 cm protruding from the umbilicus was seen; gas and intestinal contents were secreted through the tip of the mass, establishing the diagnosis of an umbilical polyp (Fig. 1). During surgery, we found that the polyp was the tip of the vermiform appendix. Appendectomy was performed with good results (Fig. 2). This mass was a terminal appendicoumbilical fistula, which consists of failure of reentry of the appendix resulting in abnormal fixation of the umbilical cord and a mobile cecum (1).

Figure 1
Figure 1
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Figure 2
Figure 2
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The most frequent umbilical mass in neonates is the umbilical granuloma followed by the umbilical polyp. The umbilical granuloma is excess granulation tissue at the base of the umbilicus after umbilical cord separation, which responds to silver nitrate (2–7). The umbilical polyp is a rare congenital lesion resulting from persistence or outgrowth of gastrointestinal mucosa of the omphalomesenteric duct retained in the umbilicus. It does not respond to silver nitrate (8).

If a polyp is diagnosed, fistulography or ultrasound can confirm communication to the bowel. An appendicoumbilical fistula should be considered in the differential diagnosis of an umbilical mass with drainage.

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REFERENCES

1. Fuijkschot J, Wijnen RMH, Gerrits GPJM, et al. A neonate with an intact congenital umbilical appendix: an alternative theory on the etiology of the appendico umbilical fistula. Pediatr Surg Int 2006; 22:689–693.

2. Nagar H. Umbilical granuloma: a new approach to an old problem. Pediatr Surg Int 2001; 17:513–514.

3. Pomeranz A. Anomalies, abnormalities, and care of the umbilicus. Pediatr Clin N Am 2004; 51:819–827.

4. Meltzer DI. A newborn with an umbilical mass. Am Fam Physician 2005; 71:1590–1592.

5. Snyder CL. Current management of umbilical abnormalities and related anomalies. Sem Pediatr Surg 2007; 16:41–49.

6. Pal K, Singh VP. Appendico-Umbilical fistula. Indian Pediatr 2006; 43:551–552.

7. Pacilli M, Sebire NJ, Maritsi D, et al. Umbilical polyp in infants and children. Eur J Pediatr Surg 2007; 17:397–399.

8. Carlisle EM, Mezhir JJ, Glynn L, et al. The umbilical mass: a rare neonatal anomaly. Pediatr Surg Int 2007; 23:821–824.

Copyright 2012 by ESPGHAN and NASPGHAN

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