Impact of umbilical polyp resection: A report and literature review.

The preferred treatment for this lesion should be the total resection of the umbilical polyp with a mini-laparotomy because residual intestinal mucosa at the umbilicus can be confirmed to eliminate the risk of recurrence.

INTRODUCTION

An umbilical polyp is a congenital lesion resulting from an intestinal mucosal remnant at the umbilicus.[1] Other anomalies involving the umbilicus include umbilical sinus, umbilical mucosal polyp and cysts within a persistent fibrous cord.[2] Cauterisation with silver nitrate for an umbilical mucosal polyp is not effective, although it is effective for an umbilical granuloma. When the umbilical mass does not regress on cauterisation with silver nitrate, an umbilical mucosal polyp should be suspected, and subsequent surgery may be required.[3] We herein report the rare cases of 4-month-old boy complicated with unusual umbilical polyp, and a 2-year-old boy, which were successfully treated surgically.

CASE REPORTS

Case 1

A male infant weighing 3790 g was delivered at 40 weeks of gestation vaginally. At the age of 4 months, he presented with a red nodule with slight discharge at the umbilicus soon after sloughing of the umbilical cord [Figure 1a]. Ultrasonography showed no sign of an urachal cyst. The nodule did not respond to silver nitrate cauterisation.

Figure 1

(a) A 1.0 cm × 1.0 cm × 0.7 cm, well-defined, red-cherry, half-moon polyp in the umbilicus. (b) Intra-operative findings. Laparotomy through an infraumbilical incision was performed. The anomalous congenital band from the umbilicus to mesenterium of the terminal ileum is shown (arrow)

Under laparotomy, the anomalous congenital band from the umbilicus to mesenterium of the terminal ileum was found, although there was no Meckel's diverticulum [Figure 1b]. The tissue underneath the umbilicus containing the peritoneum was resected, and simple excision of the band was performed. Histopathological examination of the resected polyp showed intestinal mucosa with pancreatic tissue, and examination of the band revealed fatty tissue with vessels [Figure 2a–c]. After 4 years of follow-up, there were no signs of recurrence.

Figure 2

H and E stain of the mucosal polyp, showing some parts of the epidermis and the intestinal mucosal polyp (a: ×20). Photomicrograph of the resected anomalous band showing many mature vessels and nerve fibres of different sizes (b: ×20). The umbilical polyp is composed of an aberrant pancreas (c: ×20)

Case 2

A male infant weighing 3470 g was delivered at 40 weeks of gestation vaginally. At the age of 2 years, he presented with a red nodule at the umbilicus soon after sloughing of the umbilical cord. There was an enlarging red lesion without a fistula at the umbilicus [Figure 3a]. Ultrasonography showed no sign of an urachal cyst. The nodule did not respond to silver nitrate cauterisation. These findings confirmed the diagnosis of an umbilical mucosal polyp.

Figure 3

(a) A 0.5 cm × 0.5 cm, well-defined, red-cherry, half-moon polyp in the umbilicus. (b) Intra-operative findings. Laparotomy through an infraumbilical incision was performed, and the tissue underneath the umbilicus containing the peritoneum was resected (arrow)

Laparotomy through an infraumbilical incision was performed, and the tissue underneath the umbilicus containing the peritoneum was resected [Figure 3b]. Histopathological examination of the resected polyp showed intestinal mucosa which included Paneth cells and basal stem cells in the crypts [Figure 4a–c]. After 5 years of follow-up, there were no signs of recurrence.

Figure 4

Gross lesion of the resected umbilical polyp (a). H and E stain of the mucosal polyp, showing some parts of the epidermis and the intestinal mucosal polyp (b: ×20). The mucosa of the small intestine is lined with simple columnar epithelium, including Paneth and basal cells (c: ×100)

DISCUSSION

Congenital umbilical disorders represent a group of diverse anomalies according to the embryonic remnant found in the umbilicus. The most readily apparent of these lesions is the umbilical mucosal polyp, which is the result of incomplete distal closure of the omphalomesenteric duct (OMD) at the umbilicus.[14] Its clinical presentation is usually characterized by the presence of a firm, reddish and discharging polypoid lesion.[5] Cauterisation with silver nitrate for an umbilical mucosal polyp is generally not effective.

In Case 1, ultrasonography was performed and no associated OMD anomaly was suspected. When we totally resected the umbilical mucosal polyp, we identified a congenital band that may cause intestinal obstruction and chronic abdominal pain in the future. Akgür et al. reported that one thick anomalous congenital band containing blood vessels was the cause of intestinal obstruction.[6] To the best of our knowledge, the localization of these bands excludes known embryogenic remnants such as vitelline arteries or veins or OMD, and the aetiology of these bands was obscure. It suggests that the presence of blood vessels larger than 3 mm in diameter may exclude adhesive bands that contain tiny vessels as meconium peritonitis.[6] Evaluation of the origins of the bands encountered in Case 1 suggests an anomalous congenital band to be a mesenteric anomaly.

In summary, we propose that the preferred treatment for an umbilical mucosal polyp should be the total resection of its lesion containing the peritoneum, and that the absence of intestinal mucosa at the umbilicus should be confirmed under mini-laparotomy to reduce the risk of recurrence.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.