Visual Diagnosis: 21-day-old Boy with an Umbilical Drainage

Presentation

A 21-day-old boy presents to the emergency department for the third time in 24 hours due to a 2-day history of an umbilical mass noted to be draining fluid. The mass is growing in size and increasing its drainage. The patient has an unremarkable medical history, and his umbilical stump fell off when he was 15 days old.

During the patient’s first 2 trips to the emergency department, it was assumed that he had a bleeding granuloma. He was first treated with silver nitrate and then with a porcine gelatin absorbable sponge. The physical examination during this third visit reveals a comfortable boy with an umbilical mass that is draining a blood-tinged greenish-yellow liquid. Abdominal palpation seems to cause airflow from a small stoma in the umbilical mass (Fig 1). A catheter is inserted into the stoma, and airflow through the catheter is noted. Additional imaging confirms the diagnosis.

Diagnosis

The physical examination suggests a patent omphalomesenteric duct (POMD). Ultrasonography is performed, revealing a hypoechogenic area between the umbilical mass and the small bowel. No other abdominal anomalies are observed. To better characterize the hypoechogenic mass, fistulography is performed and shows a patent duct between the stoma of the umbilical mass …