Navel fistula in newborns
Immediately after birth, a deep wound is formed at the cutting site of the umbilical cord canal. In a healthy child, it overgrows very quickly, and the crust that forms on the navel disappears on the 5-6th day of life, leaving no trace. If, after the umbilical stump falls off, the navel is a weeping wound, it is possible that the newborn has an umbilical fistula.
A navel fistula is a pathological formation in the form of a channel between the surface of the abdomen and the bladder or small intestine. The fistula canal is the yolk or urinary duct that has not closed during intrauterine development. Normally, these ducts function as part of the umbilical cord, starting from the first weeks of fetal life. They provide the fetus with nutrition. The ducts fully fulfill their function until 3-5 months of pregnancy and then are obliterated.
If, for some reason, the vitelline or urinary duct does not become infected, after the birth of the child, the vesicoumbilical or intestinal-umbilical fistula of the newborn is diagnosed.
Content:
- How does an umbilical fistula manifest?
- Umbilical fistula symptoms
- Diagnostics
- Complications
- Umbilical fistula treatment
- Secondary prevention
How does an umbilical fistula manifest?
There are complete and incomplete forms of pathology, depending on the degree of openness of the vitelline duct:
- Complete umbilical fistula - the duct is not overgrown at all, it is completely open and is directly connected to the bladder or small intestine.
- Incomplete umbilical fistula - the duct in this case has undergone partial obliteration, there is increased humidity in the navel area, but there is no urine and feces.
With a complete umbilical-intestinal fistula of newborns, feces are excreted from the navel. The child loses weight and loses weight noticeably. This condition is dangerous by the development of intestinal obstruction and is an indication for urgent surgery.
With a complete umbilical-cystic fistula of newborns, urine is released from the fistulous passage. If the baby is relaxed and calm, urine is released in the form of a few drops. During straining and straining (for example, while crying), a stream of urine is released from the navel. Through a wide umbilical-cystic fistula, the entire volume of urine can be excreted.
Umbilical fistula symptoms
The manifestations of the disease differ depending on the type of pathology.
Symptoms of a complete umbilical-cystic fistula:
- A bright red mucous membrane of the duct is visible at the bottom of the navel;
- Urine is discharged from the navel;
- From constant discharge, the skin near the navel is irritated and macerated.
If a cyst of the urinary duct joins the pathology, palpation of the anterior abdominal wall reveals a painful tumor.
Symptoms of a complete umbilical-intestinal fistula:
- A bright red mucous membrane of the duct is visible at the bottom of the navel;
- Feces are discharged from the navel;
- The skin is swollen and macerated due to the effect of intestinal secretions on it;
- Part of the small intestine may fall out through a wide fistula.
Symptoms of an incomplete umbilical fistula:
- The navel looks like a corolla of the intestinal mucosa;
- The navel tissues have undergone granulomatous changes;
- A fetid liquid or mucopurulent discharge comes out of the navel.
Diagnostics
To clarify the diagnosis, the following diagnostic methods are used:
- Ultrasonography of the umbilical cord in the region of the anterior peritoneal wall;
- Ultrasound of the abdominal cavity;
- The introduction of a contrast agent (methylene blue) into the umbilical fistula - if the contrast agent appears in the bladder, then there is a complete umbilical-cystic fistula;
- Contrast x-ray (fistulography) to differentiate between complete and incomplete fistula
- Probing the umbilical canal - insertion of the probe more than 2 cm confirms the diagnosis.
Complications
If the pathology is complicated by the appearance of a cyst of the vitelline duct, there is a high risk of infection with the latter with the development of peritonitis as a result of rupture of the suppurating formation.
Other complications:
- Hernia formation;
- Obstructive intestinal obstruction;
- Volvulus;
- Umbilical fistula infection.
An incomplete fistula can be complicated by the development of omphalitis, an inflammatory process in the tissues of the navel.
Umbilical fistula treatment
An incomplete umbilical fistula can be treated with conservative therapy. With properly selected treatment and careful observance of hygienic measures for caring for the baby, the umbilical fistula is finally tightened by 6 months of the child's life.
If there is no purulent discharge, the navel is treated at home, the following means are used for this:
- Zelenka;
- Hydrogen peroxide;
- Baneocin ointment;
- Chlorophyllipt antiseptic solution.
The release of pus, the development of the inflammatory process is a reason for the child. In the hospital, a course of treatment with antibacterial drugs is carried out, UHF therapy is used, and antiseptic treatment of the wound is carried out. If the incomplete umbilical fistula has not dragged on by 5-6 months, its surgical suturing is performed.
A complete umbilical fistula poses a danger to the life of the newborn, therefore, surgical treatment is carried out immediately. Under general anesthesia, the surgeon removes the embryonic remains of the vitelline duct. The tactics of treating an umbilical-cystic fistula consists in the isolation of the urinary duct and its further destruction.
Secondary prevention
Even carefully carried out treatment cannot be guaranteed to protect against recurrence of the disease. To prevent this from happening, it is necessary to exclude the possibility of constipation in the child, strictly observe the hygiene of the umbilical wound, and perform special exercises to strengthen the muscles of the peritoneum.
The author of the article: Sokolova Praskovya Fedorovna | Pediatrician
Education: Diploma in the specialty "General Medicine" received at the Volgograd State Medical University. A specialist certificate was immediately received in 2014.
