granuloma

Umbilical Granuloma

L. Michelle Seawright, DO, Clifford Madsen, DO, and B. Chance Gentry, MD

Melissa Kaori S. Litao, MD, and Deepak M. Kamat, MD, PhD

Children’s Hospital of Michigan, Detroit, Michigan

A 1-month-old boy presented to the clinic for a routine well-child visit. His mother brought up no concerns, but on physical examination, a soft, fleshy mass was noted to be protruding from the boy’s umbilical area. The mother denied noting any drainage from the area. The umbilical cord had fallen off before the first week of life. The infant was otherwise well. He received a diagnosis of umbilical granuloma.

The umbilical cord is formed from the combination of the yolk stalk, containing the omphalomesenteric duct, and the body stalk, containing the two umbilical arteries, the umbilical vein, and the allantois.1,2 The omphalomesenteric duct connects the fetal intestinal tract and the abdominal wall, and it is obliterated between the fifth and ninth weeks of gestation.2,3 The proximal allantois becomes the urachus, which connects the urinary bladder and the umbilicus; this should close by birth.1,2 After the umbilical cord sloughs off, usually within 2 to 3 weeks after birth, the umbilical ring becomes covered anteriorly by skin and posteriorly by peritoneum. 

If incomplete epithelialization occurs over the ring, granulation tissue may appear. Overgrowth of granulation tissue leads to the formation of an umbilical granuloma, which can be noted on physical examination as a round, wet mass, often pink or reddish, usually ranging from 3 to 10 mm in diameter. The lesion can be pedunculated.2,3

It is important to consider a patent urachus or omphalomesenteric duct in the differential diagnosis, so a history of drainage from the area (fluid in the former, and fecaloid in the latter) must be obtained.3 The diagnosis is made clinically.

Umbilical granuloma most commonly is treated with cauterization with silver nitrate, 75%. Surgical resection is an option for large granulomas or those resistant to cauterization.2,3

References

1. Moore KL, Persaud TVN, Torchia MG. The Developing Human: Clinically Oriented Embryology. 9th ed. Philadelphia, PA: Elsevier Saunders; 2013.

2. Nagar H. Umbilical granuloma: a new approach to an old problem. Pediatr Surg Int. 2001;17(7):513-514.

3. Pomeranz A. Anomalies, abnormalities, and care of the umbilicus. Pediatr Clin North Am. 2004;51(3):819-27.