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PHOTO QUIZ |
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| Year : 2011 | Volume
: 56
| Issue : 5 | Page : 607-608 |
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| Umbilical cherry |
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Bhushan Madke, Uday Khopkar
Department of Dermatology, Seth GS Medical College and KEM Hospital, Parel, Mumbai, India
| Date of Web Publication | 4-Nov-2011 |
Correspondence Address:
Uday Khopkar
Department of Dermatology, Seth GS Medical College and KEM Hospital, OPD 117, 1st Floor, Old Building, Parel, Mumbai - 400 012
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0019-5154.87175
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How to cite this article:
Madke B, Khopkar U. Umbilical cherry. Indian J Dermatol 2011;56:607-8 |
A four and half-year-old female child presented to dermatology outpatient department with complain of a single red color fleshy mass in the umbilicus since birth. There was no history of increase in size of the lesion or urinary complaint or dribbling of urine from the umbilical lesion during micturition. There was no history suggestive of abdominal pain or diarrhea. There was history of intermittent bleeding from the lesion. History was suggestive of first-degree burn over back after accidental spillage of hot water at the age of two years, followed by development of post-burn keloid.
Examination revealed a single cherry-colored papule in the umbilicus with normal surrounding skin [Figure 1]. Ultrasound of abdomen showed Meckel's diverticulum with a fibrotic strand connecting the anterior abdominal wall. Excision biopsy of the lesion was done by pediatric surgeon.
Question
What is your diagnosis?
 View Answer
Answer Persistent vitellointestinal duct  Discussion | |  |
Adam and Eve were the only individuals immune from nagging problems related to umbilicus and its adjuvant structures. Persistent vitellointestinal duct (omphalomesenteric fistula) is a rare congenital developmental anomaly of embryonic omphalomesenteric duct. [1] It results from faulty closure of vitelline duct and can manifest as (1) a persistent vitelline duct (appearing as a draining fistula at the umbilicus); (2) a fibrous band that connects the ileum to the inner surface of the umbilicus; (3) a patent vitelline sinus beneath the umbilicus; (4) an obliterated bowel portion; (5) a vitelline duct cyst; and, most commonly (97%) Meckel's diverticulum, which is a blind-ending true diverticulum that contains all of the layers normally found in the ileum and whose apex lies free in the peritoneal cavity. [2] Vitellointestinal duct anomalies can either present as an asymptomatic fleshy lesion (as in our case) or as swelling in the umbilical region. Most of the times, parents do not pay much attention to such an innocuous-looking lesion or may sometimes present to a dermatologist with a chronic discharging umbilicus. Differentials for fleshy mass in umbilical region includes umbilical granuloma, raspberry tumor, patent urachus, and umbilical hernia and rarely lobular capillary hemangioma. [3] Vitelline duct anomalies can act as a leading point for intussusception and resulting in strangulation and infarction of small bowel leading to high surgical morbidity. Because of these risks, it would appear wiser to explore the abdomen early in all babies who show intestinal mucosa at the umbilicus. Hence, it is important for a dermatologist to diagnose such conditions with reasonable accuracy and refer them to appropriate specialties for surgical intervention. To make a good diagnosis, a detailed history taking is imperative and should include the following points as mentioned in [Table 1]. Specific investigations include a thorough abdominal ultrasound with special attention paid to ileal region and an upper GI endoscopy. All suspicious lesions at the umbilical region pointing towards vitelline duct anomaly should be explored surgically and decision regarding excision can be made by operating surgeon depending upon the nature and extent of severity.
| References | | |
| 1. | Pinter A, Szemledy F, Pilaszanovich I. Remnants of vitelline duct: Analysis of 66 cases. Acta Paediatr Acad Sci Hung 1977;19:113-23. 
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| 2. | Moore TC. Omphalomesenteric duct malformations. Semin Pediatr Surg 1996;5:116-23.
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| 3. | Martin RE, Kathryn DA, Judson GR. Surgical conditions of the small intestine in infants and children. In: Zuidema GD, editor. Surgery of the alimentary tract. 3 rd ed. Philadelphia: WB Saunders; 1991. p. 308-29.
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[Figure 1]
[Table 1] |
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