The navel, the umbilical region

Fig. 1. The umbilical ring with passing embryonic vessels and ducts from the remnants of which are developing fistulas and cysts navel in children and adults: 1 - umbilical vein; 2 - umbilical-intestinal (yolk) duct; 3 - urachus; 4 - umbilical artery.
Fig. 2. Congenital umbilical hernia.

Umbilical region is part of the abdominal wall, bounded by horizontal lines, from top to connecting the ends of the X edges, bottom, front-upper spine of Ilium, the sides of the vertical lines passing through the middle of popartmix ligaments. In this area is the navel - inverted scar isformed on a place of falling of the umbilical cord. Navel covers the umbilical ring - hole in the aponeurosis of the white line of the abdomen through which blood vessels, yolk and urinary ducts penetrate into the abdominal cavity of the fetus (Fig. 1). After deciduation of funic the hole is closed; ducts taking place in it, sopostavit. The navel skin is thin, devoid of subcutaneous fat, fused with malolactic and easily expandable scar tissue of the umbilical ring, own fascia which often absent, making it the weakest area of the abdominal wall and place vyhozhdeniya hernias (Fig. 2).
In the navel can be fistula congenital and acquired. The latter are due to break through the navel of ulcers of the abdominal cavity. Operative treatment - excision navel with fistula. From benign tumors in the navel possible lipoma, fibroids, adenomas and cysts of the remnants of the yolk and the urinary tract. Malignant tumors usually secondary - metastasis of cancer of the stomach, intestines, uterus and its appendages.

The navel (umbilicus, omphalos) - scar is formed on a place of falling of the umbilical cord after birth. Located in the centre of the navel (regio umbilicalis), which is part of the anterior abdominal wall (see). The skin of the navel is the outer cover of the umbilical ring - defect white line of the abdomen, through which the antenatal period of development was held embryonic vessels (umbilical vein and artery) and channels: urinary, yolk (Fig. 1). In the navel no subcutaneous and preperitoneal fat - skin directly adjacent to the scar tissue that performed the umbilical ring. Then follow the umbilical fascia (part of the cross-fascia front abdominal wall) and the peritoneum, soldered, with a circumference of umbilical ring. In one third of cases umbilical fascia missing (A. A. Desin). The location of the navel depends on age, sex, state of the abdominal wall, etc., and on average corresponds to the level of the third and fourth lumbar vertebrae. Newborn premature babies low standing of the navel.
The umbilical ring is one of the weakest areas of the anterior abdominal wall and the place where the hernia (see).
Various pathological processes in the abdominal cavity affect the location, shape and even the color of the navel, which should be considered in the diagnosis and treatment activities. When ascites umbilicus protruding, at peritonitis, on the contrary, several retracted. In acute and chronic inflammatory processes in the abdominal cavity navel shifted and is located asymmetrically with respect to the white line. Diagnostic value has color of skin navel: it is yellow in biliary peritonitis, blue cirrhosis of the liver and stagnation in the abdominal cavity with insufficient compensation of collateral circulation, when intra-abdominal bleeding in patients with umbilical hernia. Preserving natural color of the navel in peritonitis proves vascularization of the peritoneum and is a prognostic sign.
In urgent surgery of great diagnostic value is the symptom of "creditarii navel". It is determined in the presence of air in the abdominal cavity (violation safe bodies) and at the same time umbilical hernia. The air coming through the umbilical ring, gives palpation belly feeling the crunch (as in subcutaneous emphysema).
Umbilical symptoms occupy an important place in the diagnosis of inflammation of Meckel diverticulum - the pain of this disease is constantly iradionet in the navel, are reinforced with the tightening of the abdominal wall and anterior, in some cases marked edema and hyperemia of the navel.
In the umbilical region is rich in arterial and venous communication. Arteries are located in two floors" - in the subcutaneous tissue and preperitoneal layer between both of these layers are anastomoses. Arteries are the branches of surface, upper and lower epigastric and the top of the gallbladder and the umbilical arteries, which maintain the patency in a certain part, and in the postnatal period of development (the hydrographic system of Kiriakulov). Through them you can enter the contrast and medicinal substances in the abdominal aorta. In formation of the surface of the circle at the base of the umbilical funnel participate surface, upper and lower epigastric artery.
Preperitoneal arterial circle formed mainly lower epigastric arteries, branches of the gallbladder and the umbilical arteries. Between the two "circles" there are many anastomoses playing a big role in the collateral circulation of the anterior abdominal wall.
From the veins of the navel to the system of portal vein (v. portae) are umbilical and paraumbilical Vienna (v. umbilicalis et v. paraumbilical), to the system of inferior Vena cava (v. cava inf.) - surface, upper and lower epigastric (vv. epigastriacae superficiales sup., inf.). Thus, around the navel formed the great Porto kavalenya anastomoses, which significantly extended by intrahepatic portal blocks, especially with cirrhosis of the liver (Fig. 2), and have a kind of "head of Medusa" (caput Medusa). This symptom is also of particular diagnostic value when detecting violations of the portal circulation.
The current perception of obliteration umbilical vein in extrauterine life is incorrect. This vessel is only in the state of functional closure and to a considerable extent it retains the cross. Full cross umbilical vein observed with a particular form of cirrhosis of the liver syndrome Krouvila - Baumgarten. This syndrome is characterized by strong expansion of superficial veins of the navel, splenomegaly, blowing loud noise in the navel.
The absence of morphological obliteration umbilical vein allows you to enter through it, contrast and medicinal substances in the liver [direct Raspopova pornografia (Fig. 3), regional perfusion], transfused blood. G. E. Ostroverkhov and A. D. Nikolskiy designed a simple vnebrachnyi access to the umbilical Vienna (Fig. 4). Cirrhosis, primary and metastatic liver cancer is widely used angiography through the umbilical vein. In newborns possible angiocardiography through the umbilical vein. The umbilical vein is also used to reset the part of blood from the portal system in Kavaliou with portal hypertension. For that impose vascular anastomosis between the navel and the inferior Vena cava or with one of the branches of the renal vein. G. E. Ostroverkhov, S. A. Gasparyan, E. G. Shifrin with the same purpose has developed neprostoi Porto cavalry shunt between the umbilical vein and a large subcutaneous vein of the thigh. Umbilical Vienna, situated in the round ligament of the liver, to a considerable extent takes place in the umbilical channel walls which are white line (front), umbilical fascia (back). Umbilical channel is a good reference point for the search umbilical vein.
Purulent process of umbilical wounds can cause inflammation of the skin and subcutaneous tissue at the umbilicus (see Omphalitis), and can also switch to the appropriate vascular vagina, and then to the vessel itself. In the umbilical artery can cause a blood clot in the umbilical Vienna - phlebitis, which spread to the liver, where there abscesses. Vascular lesions, often arteries, the newborn is already the beginning of sepsis (see).
Treatment of umbilical vessels inflammation includes a drip of antibiotics, blood transfusions.
The beginning of the lymphatic vessels of the navel to navel is a dense network of lymphatic capillaries that lie beneath the skin umbilical furrows and back surface
rings, under the peritoneum. On the flow of lymph is continued in three directions (threads): in axillary, inguinal and iliac lymph nodes, which is the regional to umbilical region (Fig. 5). All over from the navel to these regional areas of lymph nodes is no more. Hence the rapid spread of infections from the navel in remote areas. According to N. N. Lavrov, the movement of lymph possible by the described ways in both directions, which explains infection of the umbilical region and the navel of the primary foci in axillary and inguinal areas.
Innervation of the navel is intercostal nerves (nn. intercostales) (top departments), iliac-hypogastric nerve (nn. iliohypogastrici) and iliac-mahovymi (nn. ilioinguinales) of the lumbar plexus (the lower divisions).

Fig. 1. The umbilical ring with passing embryonic vessels and ducts from the remnants of which are developing fistulas and cysts navel in children and adults: 1 - umbilical vein; 2 - umbilical artery; 3 - urachus; 4 - umbilical-intestinal (yolk) duct.
Fig. 2. Significant expansion of collateral subcutaneous veins of the navel of cirrhosis and open the umbilical vein.
Fig. 3. Lifetime Raspopova portal venogram adult; visible portal vein. On the spine (lower) projected a catheter into the umbilical vein.
Fig. 4. The scheme operative access to the umbilical Vienna to conduct pornografii; after the assignment of the right hook rectus is clearly visible umbilical vein (4): 1 - section line; 2 - allocated rectus; 3 - the peritoneum.
Fig. 5. Lymph from the navel to navel: 1 - axillary lymph nodes; 2 - inguinal lymph nodes; 3 - iliac lymph nodes.

Fistulas and cysts umbilical-intestinal (yolk) duct. After the birth of the child's umbilical-enteric duct (ductus omphaloentericus) can maintain the patency all over, then there is a complete intestinal-umbilical fistula with the release of intestinal contents. May be patency of the ductus only near the navel - incomplete umbilical fistula. If the cleft of the middle part of the flow is formed his considerable expansion - enterolactone that can be mistaken for a tumor in the abdominal cavity. Sometimes remains a gap in part duct associated with ileum - the so-called Meckel's diverticulum. Saving of remains vitelline duct, in addition to the mentioned pathology, can cause inversions and internal hernias.
Fistulas and cysts urinary flow. Persistent throughout urachus (urachus) causes full congenital urinary fistula. When saving patency only in parts contacting with the navel or bladder, arise, respectively incomplete fistula and diverticulum. To recognize pathological consequences associated with incomplete reduction embryonic ducts, should resort to the study of secretions, sensing, fistulografii.
There are also cysts and tumors that originate from the yolk and the urinary tract.
Treatment for fistula and cysts urinary flow online.
Fistulas umbilical vessels. Cleft or delayed functional closure umbilical vein or artery leads to the formation of vascular fistula, which is one of the reasons umbilical sepsis and late bleeding from navel. There are spotting. The differential diagnosis should be borne in mind that the bleeding belly button may be endometriosis (see). Endometrioma umbilical region sharply increase during menstruation and pregnancy. Torlakson (K. Thorlakson) suggested the use of umbilical region for permanent stoma.
In the umbilical area there are specific processes. These include tuberculosis, including primary tuberculosis navel, actinomycosis, usually secondary (go with the gut), and syphilis; most often, this gum, does not exclude the possibility of the primary lesion of the navel.
Tumors of the navel are benign and malignant. Among the first most frequent lipoma, developing at the expense of the preperitoneal fat.
Frequent granuloma (fungus), which is an excessive growth of granulation when the prolonged healing umbilical wound. There are fibroids, including neurofibroma, rhabdomyomas, dermoid tumors, tumors arising on the basis of residues embryonic duct - adenoma (from umbilical-enteric duct), fibrolipoma (from urinary flow). Malignant tumors of the navel - cancer, sarcoma, as a rule, are secondary.
Injury of the navel can lead to rupture of recti and damage internal organs.