Embryology

During development the umbilicus has two umbilical arteries and one umbilical vein. The arteries are continuous with the internal iliac arteries and the vein is continuous with the falciform ligament (ductus venosus). After birth, the cord desiccates and separates and the umbilical ring closes.

Umbilical Hernia

• Up to 20% of neonates may have an umbilical hernia
• More common in premature infants
• Majority close spontaneously (may take between 12 months and three years)
• Strangulation is rare

Paraumbilical Hernia

• Due to defects in the linea alba that are in close proximity to the umbilicus
• Edges are more clearly defined than those of an umbilical hernia
• Less likely to resolve spontaneously than an umbilical hernia

Omphalitis

• Infection of the umbilicus
• Staphylococcus aureus is the commonest cause
• Potentially serious - infection may spread rapidly through umbilical vessels in neonates
• Risk of portal pyemia and portal vein thrombosis
• Treatment: combination of topical and systemic antibiotics

Umbilical Granuloma

• Cherry red lesions surrounding the umbilicus
• May bleed on contact and be a site of seropurulent discharge