The umbilicus and signs and symptoms of associated pathology

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The umbilicus and signs and symptoms of associated pathology:

The umbilicus represents the location of 4 fetal structures, 
  1. the umbilical vein, 
  2. 2 umbilical arteries, and 
  3. the urachus which is a tube extending from the superior aspect of the bladder towards the umbilicus (it represents the obliterated vesicourethral canal).
The urachus may remain open at various points leading to the following abnormalities 
  • Completely patent urachus: communicates with the bladder and leaks urine through the umbilicus. Usually doesn't present until adulthood (strong contractions of bladder of a child closes the mouth of the fistula).
  • Vesicourachal diverticulum: a diverticulum in the dome of the bladder. Usually symptomless.
  • Umbilical cyst or sinus: can become infected, forming an abscess or may chronically discharge infected material from the umbilicus. A cyst can present as an immobile, midline swelling between the umbilicus and bladder, deep to the rectus sheath. It may have a small communication with the bladder and therefore its size can fluctuate as it can becomes swollen with urine.
Other causes of umbilical masses:

Metastatic deposit (from abdominal cancer, metastatic spread occurring via lymphatics in the edge of the falciform ligament, running alongside the obliterated umbilical vein); deposit of endometriosis (becomes painful and discharges blood at the same time as menstruation).

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