Picture quiz: funny umbilical stump

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Edit: this post has been updated in March 2021

You are reviewing a baby in clinic when mum mentions incidentally that she’s noticed his umbilicus looks a bit ‘funny’ and bleeds occasionally. You pull up his top and have a look…

granuloma1

What is it?

This is an umbilical granuloma and it’s pretty common. It’s caused by a mild infection and usually appears shortly after cord separation (although there can be a delay of a few weeks).

It looks like pink or red soft tissue at the site of the umbilicus.

Sometimes they can bleed when they rub against the nappy or clothing, but otherwise can be asymptomatic.

How should I treat it?

There are two potential treatment options. Salt is now most people’s preferred option. This involves the parents applying a pinch of table salt to the granuloma and covering with gauze. They leave it on for or 20-30 mins and then rinse it off gently using gauze soaked in water. This is repeated a couple of times a day for a couple of days. There is a good guide here. Below is an image of the progression with salt treatment.

Silver nitrate is also an option although relies on the person applying it avoiding the surrounding skin, as rarely silver nitrate has caused burns – putting vaseline on the skin around the umbilicus can help protect it. The vaseline should be applied three times a day.

Is that the same for all umbilical granulomas?

This one is quite large so it’s likely to require silver nitrate.

Smaller ones can be left and will general resolve spontaneously. Some people recommend applying salt to the smaller granulomas – place it on a swab and hold it to the granuloma for 5-10 mins.

“Is there anything else I should look out for?

Look out for any urine or stool discharging from the umbilicus (suggesting uracho- or vitello-intestinal duct abnormalities). They are not very common.

Occasionally granulomas do not go away with silver nitrate and may need surgical referral.

Selected references

Disorders of the umbilicus: treatment and management. eMedicine.

Umbilical granuloma – pre-referral, RCH, Melbourne.

Image from Mike Cadogan.

About the authors

  • Tessa Davis is a Consultant in Paediatric Emergency Medicine at the Royal London Hospital and a Senior Lecturer at Queen Mary University of London.

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