Umbilical Granuloma : Blood Flow and Pathogenesis

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  • 臍肉芽腫 : その血流と発生機序
  • セイニクガシュ : ソノ ケツリュウ ト ハッセイ キジョ

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Purpose: Pathogenesis of umbilical granuloma is not well understood. We investigated blood flow of the umbilicus in umbilical granuloma and omphalitis cases in order to elucidate the pathogenesis of umbilical granuloma and mechanisms of normal umbilical formation after birth. Methods: Intraumbilical blood flows were observed by using color Doppler ultrasound in 38 cases with umbilical granuloma and 5 cases with omphalitis during the neonatal period and early infancy. Images were checked before and after treatment. Results: In the umbilical granuloma cases, 2 to 3 streaks of pulsating blood flows passing longitudinally through the umbilicus were observed. They ended mostly within the umbilicus, although some cases were connected with abdominal walls. There were no blood flows in the medial umbilical ligaments and ligamentum teres hepatis. In the omphalitis cases, low echogenic bloodless abscess cavities with increased blood flows in their walls were observed. At the healed stage of both umbilical granuloma and omphalitis, color Doppler images showed umbilical scars of about 10-mm width without blood flow. Conclusions: At the first stage of umbilical formation after birth, blood flows of umbilical arteries and vein at the very end of umbilical cord presumably persists, and bypasses systemic circulation of the abdominal wall. Slow gradual loss of this blood flow follows, leading to the formation of umbilical scars. In a couple of weeks thereafter, total shutdown of the blood supply leads to the completion of the umbilicus. Umbilical granulomas are not the result of umbilical infection, but of the residual blood flow in the umbilicus.

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