Abstract
Objectives
To report the observation of involvement of the umbilicus with alteration of its morphology in association with peritoneal tuberculosis.
Methods
This is a retrospective observational case series of abdominal tuberculosis (ATB) in children, treated in the department of pediatric surgery of a tertiary-care children’s hospital in the period from January 2004 through April 2010.
Results
Out of a total of 38 cases of ATB in children, 22(57.9%) were of the peritoneal type, 14(36.8%) were of the intestinal type, and 2(5.3%) involved the mesenteric lymph nodes. Of the patients manifesting with peritoneal tuberculosis, 11 cases (50%) had involvement of the umbilicus with changes in the umbilical shape and appearance. In seven cases the umbilicus was found retracted and transversely oriented (a slit-like “smiling” appearance) with loss of the umbilical hollow. In two cases there was puckering of the umbilicus. Other findings included umbilical erythema with inflammation in one patient and a fecal fistula at the umbilicus in another patient. While seven cases responded to treatment with antituberculous therapy (ATT), four cases underwent surgery (two laparotomy and two laparoscopy). Findings were similar in all four patients, consisting of adhered dilated bowel loops studded with tubercles which also covered the parietal peritoneum and the falciform ligament. All four cases responded to postoperative ATT.
Conclusions
Morphological changes of the umbilicus can provide an additional clue to the diagnosis of peritoneal tuberculosis in children.
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References
Sharma SP, Gangopadhyay AN, Gopal SC, Gupta DK, Yadav R. Abdominal tuberculosis in Indian children. Pediatr Surg Int. 1996;11:137–9.
Basu S, Ganguly S, Chandra PK, Basu S. Clinical profile and outcome of abdominal tuberculosis in Indian children. Singapore Med J. 2007;48:900–5.
Bills D, Moore S. The falciform ligament and the ligamentum teres: friend or foe. ANZ J Surg. 2009;79:678–80.
Iacono G, Di Prima L, D’Amico D, Scalici C, Geraci G, Carroccio A. The “red umbilicus”: a diagnostic sign of cow’s milk protein intolerance. J Pediatr Gastroenterol Nutr. 2006;42:531–4.
Rao PL, Mitra SK, Pathak IC. Spontaneous tuberculous enteroumbilical fistulas. Am J Gastroenterol. 1979;72:671–5.
Kar M, Sharma M, Garg KM, Joshi N, Vickers P. Weeping umbilicus: an unusual presentation of abdominal tuberculosis. Am J Gastroenterol. 1997;92:1230–1.
Sakamoto Y, Kamagata S, Hirobe S, Hayashi A. Umbilical shape by age and growth: a Japanese study. Plast Reconstr Surg. 2010;126:97e–8e.
Woon K, Yap Y, Cartmill M. Spontaneous umbilical CSF fistula in an adult as a complication of a ventriculoperitoneal shunt. Br J Neurosurg. 2006;20:244–6.
Okuyama H, Fukuzawa M, Nakai H, Okada A. Acquired umbilical fistula after repair of inguinal hernia: a case report. J Pediatr Surg. 1998;33:737–8.
Contributions
N P: compilation of clinical material, research articles and writing of manuscript; SRC: observation, surgical procedure, manuscript revision; AG: compilation of clinical material; PSY, JKG, RC: revision of manuscript, surgical procedure.
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Pant, N., Choudhury, S.R., Gupta, A. et al. Umbilical Signs of Peritoneal Tuberculosis in Children. Indian J Pediatr 79, 1192–1196 (2012). https://doi.org/10.1007/s12098-011-0643-2
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DOI: https://doi.org/10.1007/s12098-011-0643-2