Navel deformities are the result of congenital malformations, occur after omphalitis, are observed with umbilical hernias, are formed during pregnancy, in conditions accompanied by an increase in intra-abdominal pressure, after injuries and operations on the abdomen. May be temporary or permanent. Birth defects are sometimes combined with other developmental pathologies. The cause of the deformation is established according to the survey, external examination, ultrasonography, laboratory tests, and other studies. Treatment is often surgical.
Congenital anomalies, accompanied by deformation of the umbilical zone, are detected immediately after birth. In infants with a cutaneous navel, the skin of the abdominal wall passes over to the adjacent part of the umbilical cord. As a result, after the umbilical cord falls off, a noticeable bulge forms. As the child grows, the bulge sometimes retracts, the appearance of the navel returns to normal. But in some patients, the bulging navel persists throughout life.
Less common is a defect in which the umbilical region is not covered with skin, but with an amniotic membrane that passes to the anterior abdominal wall from the umbilical cord (amniotic navel). In this case, the fall of the umbilical cord is accompanied by the formation of a superficial wound. The deformation is temporary in nature - subsequently, the wound is gradually tightened with unchanged skin, there are no scars.
During healing, epidermal cells can get into the depth of the umbilical wound, which leads to the formation of dermoid or sebaceous cysts that deform the navel. Subsequently, such cysts can increase in size, which exacerbates the deformation. Another reason for the violation of the shape of the navel is the suppuration of the cyst, as a result of which a rough scar is formed.
In infants, complete and incomplete fistulas of the navel may also be detected. With complete fistulas, the intestine or the not closed urinary duct through the navel is connected to the external environment, in the navel zone a wound with a wide lumen is visible, through which urine or intestinal contents are excreted. With incomplete fistulas, the navel defect is practically not expressed, weeping and irritation of the skin is noted.
Infection of the umbilical wound leads to the development of inflammation of the skin and surrounding subcutaneous fatty tissue. The navel protrudes, the skin turns red and swells. Pus exudes from the wound. Deterioration of the general condition, hyperthermia, crying, appetite disorders, regurgitation are noted. Red stripes may appear on the abdomen, indicating the addition of lymphangitis. In weakened children, tissue necrosis is possible. In the outcome of omphalitis, scars are formed. The severity of the deformity of the navel depends on the severity and prevalence of the inflammatory process.
The exit of internal organs through the umbilical ring is more common in children of the first years of life, but it can also develop in adults. A severe variant of the pathology diagnosed in fetuses and newborns is an embryonic umbilical hernia (omphalocele) - a condition in which organs protrude due to underdevelopment of the abdominal wall. This defect is often combined with other severe developmental anomalies, a favorable outcome is rarely observed.
Acquired umbilical hernia in children has a more favorable course. The main symptom is the deformity of the navel. A protrusion is found in the umbilical zone, which increases with straining, coughing and crying, decreases when the child lies on his back. At the initial stage, a small spherical bulge appears in the region of the umbilical ring, which is easily reduced when pressed.
Then the diameter of the formation gradually increases to 1-5 cm. In adults, the size of the formation can reach 10-15 cm or more. With a long course, the hernia ceases to reduce due to the formation of adhesions. Formations with wide hernial orifices are asymptomatic. With narrow hernial orifices, patients are concerned about pain, nausea, constipation due to intestinal compression.
Deformity of the navel in pregnant women
The protrusion of the navel can be detected in the second half of pregnancy. Deformity is a physiological condition, caused by a rapid increase in the abdomen, disappears after childbirth. The predisposing factors that cause an early, highly noticeable change in the appearance of the navel are the presence of several fetuses, polyhydramnios, and a rapid increase in a woman's body weight.
Due to the increasing load on the abdominal wall from the inside, an increase in intra-abdominal pressure is accompanied by a protrusion of the navel of varying severity. With flatulence, the navel becomes slightly more convex than usual, the deformation is short-term, disappears after the passage of gases.
The most serious cause of protrusion of the navel due to increased internal pressure is ascites. The abdomen increases in volume, in a standing position sags down, in a prone position it spreads to the sides. The degree of deformation of the navel correlates with the amount of fluid in the abdominal cavity - the more it is, the stronger the bulge. Ascites can be observed with portal vein thrombosis, portal hypertension, peritoneal carcinomatosis. With chronic renal failure, it is combined with anasarca. In rheumatic diseases, it is supplemented with hydrothorax, arthralgia.
Other possible causes of navel deformity are scars due to surgical operations on the abdominal organs, injuries of the anterior abdominal wall, and local infectious processes. Sometimes the aesthetic characteristics of this anatomical region deteriorate with sagging tissues after pregnancy or sudden weight loss.
In newborns and young children, the cause of the deformity of the navel is determined by a neonatologist or pediatrician. Adult patients are most often examined by a surgeon. During the survey, the specialist finds out when the shape of the navel changed, what symptoms it was accompanied by, how quickly it developed. During the examination, the doctor assesses the general condition of the patient and the appearance of the abdomen, performs palpation and percussion. Based on the results of the physical examination, the following procedures can be prescribed to the patient:
Pregnant patients are shown scheduled ultrasound and laboratory tests on time. If a pathological course of gestation is suspected, an unscheduled examination is recommended.
Belly button shape correction
Infants with an amniotic navel are given daily dressings with aerosols that create a protective film on the surface of the wound. Small dermoid and sebaceous cysts are subject to regular monitoring. In children of the younger age group, umbilical hernias can regress on their own, so patients under 5 years of age are observed, exercise therapy is prescribed, abdominal massage, and a bandage is applied to the navel.
With ascites, the underlying pathology is treated. To reduce the amount of effusion, a salt-free diet, fluid restriction, and diuretics are recommended. Carry out correction of violations of water-salt metabolism. Hepatoprotectors are used, ACE inhibitors are used to reduce pressure in the portal vein system. Perform albumin and plasma infusions.
Intervention is necessary for all infants with omphalocele. Most children are operated on in the first days of life. The option of eliminating the defect is chosen taking into account the volume of the protrusion. In mild cases, the internal organs are simultaneously immersed in the abdominal cavity, the abdominal wall is sutured. In case of large hernias, the organs are protected with a silicone bag, and then gradually moved into the abdominal cavity. In the presence of other severe developmental anomalies, children are treated conservatively until a massive ventral hernia is formed, which is also subsequently sutured.
In patients with sebaceous and dermoid cysts, with the growth of the formation, excision of the cyst is recommended. In case of infection of cysts, formation of abscesses in patients with omphalitis, an autopsy and drainage of abscesses are indicated. Uncomplicated umbilical hernias are operated on in a planned manner. Hernioplasty is performed using local tissues or mesh prostheses. When a hernia is incarcerated, an urgent operation is required - dissection of the infringing ring, sometimes resection of the intestine.
With the ineffectiveness of conservative measures in patients with ascites, a laparocentesis is performed or a peritoneal catheter is installed. Otherwise, the tactics of surgical treatment of ascites depends on the nature of the underlying pathology. Portocaval shunting, reduction of the splenic duct, splenectomy, formation of a lymphovenous anastomosis, removal of the peritoneum are possible.