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

Catarina S. Oliveira; Inês Pessanha; Liliana Santos; Marta Machado; Raquel Zenha

doi:10.1542/pir.2017-0206

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Catarina S. Oliveira, MD, MMed*
Inês Pessanha, MD, MMed^†
Liliana Santos, MD, MMed^†
Marta Machado, MD, MMed*
Raquel Zenha, MD*

^*Department of Pediatrics, Baixo Vouga Medical Center, Aveiro, Portugal
^†Department of Pediatric Surgery, Coimbra Hospital and Universitary Centre, Coimbra, Portugal

AUTHOR DISCLOSURE
Drs Oliveira, Pessanha, Santos, Machado, and Zenha have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

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.

Figure 1.

Photograph of the umbilical mass where a small stoma is seen (white arrow).

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 …