DOI: 10.4103/jiaps.jiaps_181_24 ISSN: 0971-9261

A Study of Symptomatic Umbilical Remnants in Children with Evaluation of the Role of Ultrasound as a Diagnostic Modality

Rohit Bhashkar Meshram, Ashitosh D. Pokharkar, S. Lakshmilekiya, Ravi Shankar Solanki, Amit Gupta, Partap Singh Yadav, Subhasis Roy Choudhury, Rajiv Chadha
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BSTRACT

Aims:

The aim of this study was to study the presentation and management of children with symptomatic “umbilical remnants” (SUmR) and the efficacy of ultrasound (US) in diagnosis and predicting a need for surgery.

Materials and Methods:

This study included 65 children aged 2 months–12 years with clinical findings suggestive of umbilical remnants (UmR): umbilical granuloma (UG); umbilical polyp or prolapsing mucosa, periumbilical inflammation/mass, or persistent umbilical discharge. Investigations included US and bacteriological culture-sensitivity tests of umbilical discharge. UG and umbilical polyps were excised. Minilaparotomy was performed for other SUmR and UG/umbilical polyps where US suggested intra-abdominal pathology. The excised UmR tissue underwent histopathologic examination (HPE) for final diagnosis.

Results:

There were 40 males and 25 females, with a median age of 6 months. The three groups after final diagnosis were (i) UG (n = 38), (ii) vitellointestinal (VI) remnants (n = 21), umbilical polyp (n = 17), patent VI duct (PVID) (n = 3), and umbilical cyst (n = 1), and (iii) urachal remnants (UR) (n = 6), urachal cysts (n = 3) and patent urachus (n = 3). Forty-nine UG/umbilical polyps underwent simple excision. Sixteen (24.6%) patients underwent minilaparotomy, and in seven, US findings correlated with operative findings. US was false positive for intra-abdominal pathology in six cases (UG = 3; umbilical polyp = 3) and false negative in PVID (n = 3). UG and umbilical polyps were differentiated only by HPE. There were no complications or recurrence. On grouping by presentation, US as a diagnostic modality in UG/umbilical polyp had a specificity of 85% with a diagnostic accuracy of 89.09%. In UR, the figures were sensitivity 100%, specificity 0%, positive predictive value (PPV) 100%, negative predictive value (NPV) 0%, and diagnostic accuracy 100%. For VID remnants excluding umbilical polyps, the sensitivity was 25%, specificity 0%, PPV 100%, NPV 0%, and diagnostic accuracy 25%. Overall, the sensitivity of abdominopelvic US as a diagnostic modality in SUmR was 70%, specificity 89%, PPV 53%, and NPV 94% with overall diagnostic accuracy of 84%.

Conclusions:

SUmR is most commonly UG or umbilical polyp and could not be differentiated on clinical grounds alone. In suspected urachal anomalies/UR, US is an effective diagnostic modality. Overall, however, US has relatively low sensitivity and a low PPV and should be regarded as an accessory rather than a very effective diagnostic modality in SUmR. One-stage excision of SUmR is safe and effective. HPE of the excised SUmR is essential for the final diagnosis.

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