Umbilical urachal fistula

　　The etiology of umbilical urachal fistula is not fully understood. Although some people believe it is related to urinary tract obstruction, in fact, only 14% of neonates with umbilical urachal fistula have evidence of obstruction; not all patients with severe posterior urethral valves have concurrent umbilical urachal fistula. Moreover, the closure of the urachus occurs before the formation of the urethra.

　　Due to the long-term secretion of the umbilicus, it is easy to cause infection of the umbilicus, with symptoms such as redness, swelling, heat, and pain. In severe cases, the infection can spread from the umbilicus directly into the umbilical vein, causing sepsis. Patients may present with symptoms such as high fever, chills, vomiting, and abdominal pain. Once the above symptoms occur, blood culture examination should be performed to identify the pathogen, and antibacterial treatment should be carried out according to the type of infection.

　　The etiology of umbilical urachal fistula is not yet completely clear. Umbilical urachal fistula is characterized by the umbilicus not drying up and always having thin secretions. Umbilical urachal cysts are manifested as cystic masses in the midline of the lower abdomen, which do not change with body position.

　　Umbilical urachal cysts and fistulas are the main causes of umbilical infections in children. If a child's umbilicus has leakage, it should be considered as a disease and a doctor should be consulted for treatment. Delaying the condition can lead to the spread of infection and endanger the child's life. Early detection, early diagnosis, and early treatment of the disease are of great significance for indirect prevention of the disease.

　　If methylene blue is injected into the bladder through a catheter or urethra, blue urine can be seen to flow out of the umbilicus or be excreted through the urethra. If the above conditions occur, it is necessary to consider the possibility of umbilical urachal fistula. Cystography of the urinary bladder and urethra not only can exclude urethral obstruction but also can understand the specific location of the fistula and the size of the fistula orifice. As for cystoscopy, it is not completely necessary. Cystoscopy can be performed for those who need to be differentiated from other malformations.

　　Patients with umbilical urachal fistula should have a light diet, eat more vegetables and fruits, rationally match the diet, and pay attention to adequate nutrition. It is necessary to pay attention to reasonable nutrition, and try to make the food diverse, eat more high-protein, high-vitamin, low-animal-fat, easily digestible foods and fresh fruits and vegetables, and avoid eating stale, deteriorated, or stimulating things. Eat less smoked, roasted, pickled, fried, and salty foods. The main staple foods should be mixed with coarse and fine grains to ensure nutritional balance. If newborns need to strengthen breastfeeding and auxiliary feeding, strengthen care.

　　The treatment is the surgical removal of the fistula, along with the umbilical cord, and the top of the bladder fistula is sutured. A catheter or stent may be left in place after surgery. It is necessary to pay attention to the possibility of umbilical urachal fistula secondary to lower urinary tract obstruction. If there is lower urinary tract obstruction, it should be relieved.