Endgames Case Review

A baby with a discharging umbilical lesion

BMJ 2016; 355 doi: http://dx.doi.org/10.1136/bmj.i5587 (Published 26 October 2016) Cite this as: BMJ 2016;355:i5587
  1. Leigh N Sanyaolu, general practice specialty trainee1,
  2. Muhammad Javed, plastic surgery specialty registrar1,
  3. Nick Wilson-Jones, consultant paediatric plastic surgeon1
  1. 1Plastic and Reconstructive Surgery, Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
  1. Correspondence to: L N Sanyaolu lnsanyaolu{at}doctors.org.uk

An 8 week old boy was referred by his general practitioner with a persistent oozing red umbilical lesion (fig 1). He was born by normal vaginal delivery, with no complications during the pregnancy or at birth. The child had no medical history. He was bottle fed and putting on weight as expected.

Fig 1

On examination, the child was systemically well. A red lesion with a serous discharge was observed at the umbilicus. There was no surrounding cellulitis or clinical evidence of infection.

Questions

  • What is the most likely diagnosis?

  • What are the important differential diagnoses to consider?

  • What is the most appropriate management of this condition?

Answers

What is the most likely diagnosis?

Short answer

The most likely diagnosis is an umbilical granuloma.

Discussion

Umbilical granulomas occur when there is excessive inflammation and granulation tissue formation at the umbilicus after separation of the umbilical cord.1 2 It typically presents in the first few weeks of life with a serous or serosanguinous discharge from the umbilicus.3 It is a common condition and macroscopically consists of red, circular, and pedunculated lesions (fig 1), varying in width from 3 mm to 10 mm.1 2 3 The lesions are generally friable and can bleed with minimal contact.1 2 3 They are not true congenital lesions, and are therefore not associated with any underlying structural abnormality.4

What are the important differential diagnoses to consider?

Short answer

The important differential diagnoses to consider are congenital abnormalities of the gastrointestinal and urinary …

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