Reporte de un caso de una fístula apendico-umbilical

Cura Esquivel, Idalia Aracely

Garza Luna, Ulises

Gaytan Saracho, Diego

Montes Tapia, Fernando Félix

O Cavazos, Manuel Enrique de la

Journal of Pediatric Gastroenterology and Nutrition

Fernando Montes-Tapia

Ulises Garza-Luna

Idalia Cura-Esquivel

Diego Gaytan-Saracho

Manuel de la O-Cavazos

Crossref

Appendicoumbilical Fistula

Repositorio Academico Digital UANL

MPG/202144; Total nos of Pages: 1;MPG 202144Appendicoumbilical Fistula, a Cause ofan Umbilical Mass With DrainageFernando Montes-Tapia, Ulises Garza-Luna,Idalia Cura-Esquivel, Diego Gaytan-Saracho, andManuel de la O-CavazosA 2-month-old boy was referred with an umbilical granulomatreated with silver nitrate without involution. A firm red mass1.3 cm 0.5 cm protruding from the umbilicus was seen; gas andintestinal contents were secreted through the tip of the mass,establishing the diagnosis of an umbilical polyp (Fig. 1). Duringsurgery, we found that the polyp was the tip of the vermiformappendix. Appendectomy was performed with good results (Fig. 2).This mass was a terminal appendicoumbilical fistula, whichconsists of failure of re-entry of the appendix resulting in abnormalfixation of the umbilical cord and a mobile cecum (1).The most frequent umbilical mass in neonates is theumbilical granuloma followed by the umbilical polyp. Theumbilical granuloma is excess granulation tissue at the base ofthe umbilicus after umbilical cord separation, which respondsto silver nitrate (2–7). The umbilical polyp is a rare congenitallesion resulting from persistence or outgrow of gastrointestinalmucosa of the omphalomesenteric duct retained in the umbilicus.It does not respond to silver nitrate (8).If a polyp is diagnosed, fistulography or ultrasound canconfirm communication to the bowel. An appendicoumbilicalfistula should be considered in the differential diagnosis ofan umbilical mass with drainage.REFERENCES1. Fuijkschot J, Wijnen RMH, Gerrits GPJM, et al. A neonate with an intactcongenital umbilical appendix: an alternative theory on the etiology of theappendico umbilical fistula. Pediatr Surg Int 2006;22:689–93.2. Nagar H. Umbilical granuloma: a new approach to an old problem.Pediatr Surg Int 2001;17:513–4.3. Pomeranz A. Anomalies, abnormalities, and care of the umbilicus.Pediatr Clin N Am 2004;51:819–27.4. Meltzer DI. A newborn with an umbilical mass. Am Fam Physician2005;71:1590–2.5. Snyder CL. Current management of umbilical abnormalities and relatedanomalies. Sem Pediatr Surg 2007;16:41–9.6. Pal K, Singh VP. Appendico-Umbilical fistula. Indian Pediatr 2006;43:551–2.7. Pacilli M, Sebire NJ, Maritsi D, et al. Umbilical polyp in infants andchildren. Eur J Pediatr Surg 2007;17:397–9.8. Carlisle EM, Mezhir JJ, Glynn L, et al. The umbilical mass: a rareneonatal anomaly. Pediatr Surg Int 2007;23:821–4.FIGURE 1. Intestinal drainage through the tip of the umbilicalmass.FIGURE 2. (A) Dissection of polyp that is continuous with theintestine; (B) Polyp identified as the tip of the appendix with itsbase attached to the cecum. Asterisk: polyp, arrowhead: baseof the appendix attached to the cecum, arrow: terminal ileum.Received November 18, 2011; accepted December 30, 2011.From the Department of Pediatrics, ‘‘Dr Jose E. Gonzalez’’ UniversityHospital, Universidad Autonoma de Nuevo Leon, Monterrey, NuevoLeon, Mexico.Address correspondence and reprint requests to Dr Fernando Montes-Tapia, Associate Professor of Pediatrics and Surgery, Department ofPediatrics, ‘‘Dr Jose E. Gonzalez’’ University Hospital, UniversidadAutonoma de Nuevo Leon, Madero y Gonzalitos s/n, Monterrey, NuevoLeon 64460, Mexico (e-mail: fernando.montestp@uanl.edu.mx).The authors report no conflicts of interest.Copyright # 2012 by European Society for Pediatric Gastroenterology,Hepatology, and Nutrition and North American Society for PediatricGastroenterology, Hepatology, and NutritionDOI: 10.1097/MPG.0b013e3182491483CASE REPORTJPGN  Volume 00, Number 00, Month 2012 1

Appendicoumbilical fistula, a cause of an umbilical mass with drainage

http://eprints.uanl.mx/9439/1/2012Ap%C3%A9ndiceUmbilical.pdf

Appendicoumbilical fistula, a cause of an umbilical mass with drainage

Abstract

Similar works

Full text

Available Versions

Crossref

Repositorio Academico Digital UANL