Umbilical Granuloma: Modern Understanding of Etiopathogenesis, Diagnosis, and Management

Abstract

Umbilical granuloma is a small swelling composed of granulation tissue at the base of the umbilicus. It is a relatively common problem in neonatal period, encountering after separation of the umbilical cord. The granuloma is thought to develop in response to subclinical infection or inadequate epithelialization of umbilical cord stump. The main clinical symptoms are umbilical discharge and swelling. Physical examination shows a small, moist, fragile and pinkish/red lesion at the umbilicus. Besides some benign soft tissue tumors, vitellin duct anomalies or urachal remnants should be considered in the differential diagnosis. The issue of what is the best treatment option is still controversial. Although silver nitrate application is the most common one among the actual treatment options, other therapeutic methods are also available. These include common salt application, topical antiseptics/antibiotics/steroids, ligation, excision, electrocautery, and cryotherapy. At the current practice, common salt application is suggested if silver nitrate cannot be used as the first option. In patients with treatment-resistant cases, excision should be done after ruling out other potential diseases. A detailed work-up is needed if the lesion has equivocal clinical characteristics or do not respond to therapeutic interventions mentioned above.