In newborns, the umbilical cord normally falls off between the 3rd and 10th day of life. A (dry) scar then forms in the middle of the abdomen (= umbilicus). In some children, however, the umbilicus does not dry out; a more or less strong secretion of mostly clear fluid from the umbilicus is observed for weeks after the umbilical cord has fallen off.

Possible causes:

- Umbilical inflammation
- Umbilical granuloma
- Persistence of the urachal duct
- Persistence of the omphaloenteric duct

A weeping navel can be caused by various congenital and acquired causes. Acquired causes include umbilical inflammation (so-called omphalitis caused by bacteria, a typical clinical picture in developing countries) or umbilical granuloma. The latter is a growth of tissue at the base of the clamped umbilical cord.

Congenital causes include connections from the navel to internal organs that occur naturally as part of the child's development before birth. Normally, this connection disappears after birth at the latest, leaving only a closed cord of connective tissue. Persistence of the so-called "urachus" is a malformation in which the section of the "allantois" (temporary embryonic structure) between the navel and the bladder does not completely regress. Depending on the extent to which the allantois remains (persists), it is referred to as urachal sinus, urachal cyst, urachal diverticulum and urachal fistula (Fig. 1). If a urachal fistula is present, this leads to the typical picture of a weeping navel with leakage of clear fluid, which in this case is urine.

Persistence of the omphaloenteric duct (remnant of the so-called embryonic vitelline duct) means that the duct between the small intestine and the navel (Fig. 2), which was created during embryonic development, continues to exist, which is why stool may be discharged via the navel.

In addition to a physical examination, the diagnosis of a weeping navel usually also includes ultrasound diagnostics. This may reveal connections to internal organs. In addition, examination of the secretion for urinary substances can provide indications that the secretion is urine, for example, which must come from the bladder, which is only possible via a urachus.

Omphalitis is treated with antibiotics, the umbilical granuloma by local cauterization with silver nitrate or, in the case of larger granulomas, by surgical removal. If there are remnants of the omphaloenteric duct or urachus, the navel must be examined during an operation and the persistent duct must be exposed and closed up to the transition to the bladder roof or small intestine.

The first contact is usually made through an outpatient information meeting in our pediatric surgery outpatient clinic (see below for contact details). Please bring all existing examination results (e.g. ultrasound findings) with you to the first consultation. The diagnosis will be made on the basis of a combination of the information you provide and the ultrasound, which can usually detect a persistent connection between the umbilicus and the bladder or bowel. In individual cases, it may be necessary to fill the bladder with contrast medium via the urethra (so-called micturition cysturethrography or "MCU") or to visualize the duct system directly from the navel using a contrast medium.

 

 

If an umbilical granuloma is present, it can either be surgically removed or cauterized with silver nitrate. An umbilical infection is treated with antibiotics. If incomplete or absent regression of the urachus or omphaloenteric duct is suspected, your child's navel must be examined in the operating room. You will then come to our day ward with your child on the day of the operation. During the operation, we will make a small abdominal incision at the navel, expose the connecting duct between the bladder or small intestine and the navel and remove it. In the case of an omphaloenteric duct, sometimes a few centimetres of the small intestine must also be removed. In individual cases, it may also be necessary to perform a laparoscopy and remove the incomplete or absent regression of the urachus or omphaloenteric duct laparoscopically. We will discuss the best surgical technique for your child with you before the procedure.

After the operation, your child will initially remain in the recovery area, where you will be able to sit up in bed again. You will then be transferred to the normal ward. A few hours after the operation, your child will usually be able to eat again. If your child feels well after the operation, you can be discharged home on the evening of the operation (outpatient operation). In individual cases, however, observation may be necessary until the next day.

After the operation, the belly button usually looks a little unusual. However, it usually returns to its normal shape within the first 12 months.

We use absorbable suture material for the skin suture so that a suture pull is not usually necessary. If the wound is not irritated, further wound checks can be carried out by your pediatrician. However, if you still have questions about the operation itself or if we consider an earlier follow-up examination to be appropriate in individual cases, you can arrange an outpatient appointment at any time.