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Clinical Summary

An umbilical granuloma is granulation tissue with incomplete epithelialization that persists following cord separation. It is the most common cause of an umbilical mass in neonates. Parents will describe a persistent discharge from the umbilicus after the cord has dried and separated. It appears soft, pink, wet, and friable. Infants with an umbilical granuloma do not have localized swelling, redness, warmth, tenderness, or fever. An umbilical polyp is a rare anomaly resulting from the persistence of the omphalomesenteric duct or the urachus and may have a similar appearance. A polyp is usually firm with a mucoid secretion. The differential diagnosis also includes omphalitis, an infection of the umbilicus and surrounding structures, which should be considered in ill-appearing neonates.

Management and Disposition

Advise parents to keep the granuloma dry and exposed to the air as often as possible. Cleaning and drying of the umbilical cord base with alcohol is unnecessary and may irritate the skin and delay healing. Cauterization of the granuloma by application of topical silver nitrate is the treatment of choice. It is important to protect the surrounding skin (apply petroleum jelly or antibiotic ointment) and remove excess silver nitrate to avoid chemical burns and skin staining. The cauterization may need to be repeated at 3-day intervals if drainage persists. Topical steroids have shown success in treating umbilical granulomas, but further studies are needed to assess safety and noninferiority.

FIGURE 14.10

Umbilical Granuloma. Newborn infant with umbilical granuloma visible in umbilicus. (Photo contributor: Anne W. Lucky, MD.)

Pearls

  1. An umbilical granuloma is the most common umbilical mass in neonates.

  2. The only sign of granuloma formation may be the presence of nonpurulent discharge noted in the diaper area or on clothing that is in contact with the umbilicus.

  3. Omphalitis presents with redness of the periumbilical area typically tracking upward in the midline and often with a purulent discharge from the umbilicus. It can progress to abdominal wall cellulitis or peritonitis and requires a complete sepsis workup and hospital admission for treatment with broad-spectrum parenteral antibiotics.

FIGURE 14.11

Omphalomesenteric Duct. This red mass resembling a granuloma was found to be an omphalomesenteric duct. (Photo contributor: Kevin J. Knoop, MD, MS.)

FIGURE 14.12

Omphalomesenteric Duct. A fistulogram confirms continuity between the duct and intestine. (Photo contributor: Kevin J. Knoop, MD, MS.)

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