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Background: Omphalophlebitis is characterized as an omphalopathy that affects the umbilical vein. In these cases, ultrasonography can help identify the severity of abdominal lesions and guide the choice of treatment. Marsupialization of the umbilical vein is a surgical procedure indicated in cases where this vessel presents with purulent secretion up to the liver parenchyma. This report describes a case of omphalophlebitis in a calf treated by marsupialization of the umbilical vein. The preoperative and postoperative sonographic findings are also described. Case: A 4-day-old Holstein calf was attended at the Veterinary Hospital (HV) of the Universidade Federal de Goiás (UFG), Goiânia, Brazil. On physical examination, the animal was found to be apathetic, with tachycardia, tachypnea, hyperthermia, hyperemic mucous membranes, and moderate dehydration. An increase in volume was observed in the umbilical region, with local hyperthermia, firm consistency, and sensitivity to palpation. On deep palpation of the abdomen, a mass originating in the umbilical region and extending cranially was observed, leading to the suspicion of omphalophlebitis. Abdominal ultrasonography revealed external umbilical abscess and omphalophlebitis. Initially, conservative treatment with antibacterial and anti-inflammatory drugs was performed; however, there was no improvement in the clinical picture. Therefore, exploratory celiotomy was performed to remove the umbilical infectious focus. During the procedure, it was verified that the umbilical vein was dilated with a thickened wall until its insertion in the hepatic parenchyma, hence removal of the infected region through a ligature was not possible. Thus, marsupialization of the umbilical vein was performed to create a cutaneous opening for drainage of the purulent contents. In the postoperative period, antibacterial, anti-inflammatory, and analgesic drugs were administered. Dressing of the surgical wound and of the umbilical vein lumen was performed with topical polyvidone at 0.2%. Removal of the stitches was done 14 days postoperatively. Weekly ultrasonographic examinations were performed, which showed a gradual reduction in the diameter of the umbilical vein throughout the postoperative period. Thirty days after the surgical procedure, no further drainage of the purulent content was observed from the umbilical vein, and healing of the stump was demonstrated. After 7 months, a repeat ultrasonography was performed, revealing normal echogenicity and echotexture of the hepatic parenchyma and complete atrophy of the umbilical vein. Discussion: Umbilical vein marsupialization is a surgery rarely described in the literature, and no report has followed the evolution of a case by ultrasonography. The ultrasound examination of the umbilical structures was essential for the definitive diagnosis and choice of surgical treatment. Marsupialization of the umbilical vein was chosen due to the impossibility of ligature of this vessel, which presented with thickened walls and lumen filled with purulent content until its insertion into the liver. Postoperative monitoring via serial ultrasonography examinations allowed follow up of the evolution of the case and animal recovery. At the sonographic reevaluation after 7 months, the findings were unremarkable, indicating complete recovery of the patient. Umbilical marsupialization is a surgical technique that allows complete recovery of calves with severe omphalophlebitis. Ultrasonography is fundamental for the diagnosis of omphalophlebitis and in determining the best therapeutic protocol. Sonographic evaluation during the postoperative period allows follow-up of the progression of lesions in abdominal structures and helps in defining the prognosis.

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INTRODUCCIÓN: La endometriosis es una patología benigna, dependiente de estrógenos, en la que el tejido que normalmente crece dentro del útero aparece fuera de este. Su localización habitual es en la pelvis, pero en ocasiones puede aparecer en otras áreas, como es el caso de la endometriosis umbilical. OBJETIVO: Familiarizar al ginecólogo con esta patología y entregar una serie de herramientas para diagnosticar, tratar y seguir a las pacientes que la presentan. CASOS CLÍNICOS: Se presentan dos casos clínicos de endometriosis umbilical primaria diagnosticados en el Hospital La Paz, en Madrid (España), entre los años 2018 y 2019. Las pacientes, de 30 y 34 años, consultaron por dolor o sangrado umbilical durante la menstruación. Ninguna tenía antecedentes de patología ginecológica ni cirugía abdominal previa. Tras una exhaustiva exploración física y una ecografía de alta resolución, se decidió extirpar la lesión con la colaboración del servicio de cirugía plástica. En ambos casos, el estudio anatomopatológico confirmó que se trataba de tejido endometriósico. Las dos pacientes presentaron una buena evolución posquirúrgica, sin recidivas hasta la fecha. CONCLUSIONES: La endometriosis umbilical primaria es una patología infrecuente, pero es necesario incluirla en el diagnóstico diferencial de una mujer con un nódulo umbilical. Siempre deben realizarse una exploración física exhaustiva y una ecografía ginecológica, para descartar posibles patologías concomitantes. El tratamiento de elección es la extirpación quirúrgica de la lesión y el diagnóstico final se establece con el estudio anatomopatológico.

INTRODUCTION: Endometriosis is an estrogen-dependent benign pathology in which endometrial tissue develops outside the uterus. Its most frequent location is the pelvis, although it can appear in other areas such as the umbilicum. OBJECTIVE: To familiarize the gynecologist with this pathology and provide a series of tools to diagnose, treat and provide continued care to these patients. CASE REPORTS: Retrospective study of two clinical cases of primary umbilical endometriosis diagnosed at La Paz University Hospital, in Madrid (Spain), between 2018 and 2019. Both patients (30 and 34 years old respectively) presented with pain and/or bleeding around the umbilical area during menstruation. Neither of them had any previous gynecologic conditions or abdominal surgeries. After exhaustive physical examination and a high-resolution ultrasound, lesions were surgically removed in collaboration with the plastic surgery department. In both cases, histology confirmed the presence of endometrial tissue. Both patients made a full recovery after surgery and havent had a recurrence of said lesions. CONCLUSIONS: Primary umbilical endometriosis is an infrequent disease. However, it must be included in the differential diagnosis of umbilical nodes in women. Exhaustive physical examination and gynecologic ultrasound should always be performed to rule out any other pathologies. Surgical removal of the nodes is the preferred treatment, and the final diagnosis is reached through histology.

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The objective of this study was to determine the types of calve housing used in dairy farms, the prevalence of umbilical disorders and related risk factors. The 16 farms studied were visited to characterize the types of installation and possible risk factors, as well as information obtained from a questionnaire applied to the farmers. 806 Holstein calves were physically examined, in addition to collecting blood samples for the evaluation of Failures in Passive Immunity Transfer (FPIT), in animals that manifested inflammatory omphalopathies, and were also submitted to ultrasound examination. The prevalence of omphalopathies was assessed by Fisher's test, and multivariate logistic regression to assess risk factors. Eight types of installation were found: tropical house, suspended cage, collective stall, collective picket, Argentinean type, single-story cage, individual stall, and collective picket with chain. Omphalopathies accounted for 6.45% of the calves. Small size farms (up to 99 lactation cows) had high risk for umbilical disorders, ground floor collective calves, without side protection, with sand floor, in closed sheds and without heatstroke were considered risk factors for omphalopathies. Adequate colostrum and umbilical antisepsis are not associated with disease, its appearance being related to the housing conditions of the animals.(AU)

O objetivo deste estudo foi determinar os tipos de alojamento para bezerros leiteiros, a prevalência de onfalopatias e os fatores de risco relacionados. As 16 fazendas estudadas foram visitadas buscando-se caracterizar os tipos de instalação e os possíveis fatores de risco, além de informações obtidas de um questionário aplicado aos fazendeiros. Foram examinados fisicamente 806 bezerros da raça Holandesa, além da coleta de amostras de sangue, para avaliação da falha de transferência de imunidade passiva (FTIP), nos animais que manifestaram onfalopatias inflamatórias, sendo submetidos também ao exame ultrassonográfico. A prevalência das onfalopatias foi avaliada por teste de Fisher, e foi feita regressão logística multivariada a fim de se avaliarem os fatores de risco. Verificou-se oito tipos de instalação: casinha tropical, gaiola suspensa, baia coletiva, piquete coletivo, bezerreiro tipo argentino, gaiola térrea, baia individual e piquete coletivo com corrente. As onfalopatias corresponderam a 6,45% dos bezerros. Os bezerreiros coletivos térreos, sem proteções laterais, com piso de areia, borracha, concreto ou madeira, em galpões fechados, sem insolação, com alta densidade animal, antissepsia umbilical realizada por três dias e FTIP acima de 50% foram considerados fatores de risco para onfalopatias e possuem relação com o bezerreiro, sendo decisivas para evitar essas condições a colostragem e a antissepsia umbilical adequadas.(AU)

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Resumen Introducción: El quiste pilonidal del ombligo (QPO) es una entidad muy infrecuente y por eso no es reconocida precozmente. El objetivo de este manuscrito es dar a conocer esta patología. Reporte de casos: Presentamos dos pacientes referidos por un proceso inflamatorio del ombligo, con descarga de mal olor. El primer paciente, luego de dos meses de tratamiento local sin resolución, es intervenido resecando la lesión umbilical, comprobando en ese momento la existencia de contenido piloso en el quiste. En el segundo paciente se plantea el diagnóstico durante la anamnesis y se confirma con el examen físico. En ambos casos se efectuó una resección parcial del ombligo incluyendo la lesión pilonidal. La biopsia confirmó el diagnóstico. El resultado posoperatorio ha sido satisfactorio y sin recaídas. Discusión y Conclusión: Hay escasa literatura relacionada con el QPO. Se proponen el tratamiento conservador y la opción de resección quirúrgica del quiste. En nuestra limitada experiencia se procedió a resecar la lesión y recomendar la depilación de la región periumbilical. No podemos descartar la alternativa de manejo conservador en futuros casos, antes de proponer la cirugía.

Introduction: Umbilical pilonidal sinus (UPS) is a rare condition and is therefore not detected early. The aim of this document is to discuss this pathology. Case report: We present two patients referred due to an inflammatory process of the navel, with the presence of a malodor. The first patient, after two months of unsuccessful local treatment, was intervened by a resection of the umbilical lesion, verifying hair content in the sinus. In the second patient the diagnosis was evident during anamnesis and confirmed with the physical examination. In both cases, a partial resection of the umbilicus was performed, including the pilonidal sinus. Biopsy confirmed the diagnosis. The postoperative result has been satisfactory, without relapse. Discussion and Conclusion: There are not much literature related to UPS. Conservative treatment or surgical resection of the sinus is proposed. In our limited experience we proceeded to a surgical resection of the lesion and recommend eliminating the hairs of the periumbilical region. We cannot rule out the conservative management option in future cases, before proposing surgery.

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Nevoid acanthosis nigricans is a rare, benign form of acanthosis nigricans. Of the 24 cases documented in the literature, only two are exclusively localized to the umbilicus. We present four cases of nevoid acanthosis nigricans localized to the umbilicus; in patients less than 25 years of age, with no known co-morbidities, three of whom were females. Two of the cases received, with good response, treatment based on topical calcipotriol, a medication not previously reported to be used for this indication. Contrary to other types of acanthosis nigricans, the nevoid acanthosis nigricans is not associated with any syndrome, endocrinopathy, obesity, medication, or neoplasia and it can be confused with other pathologies such as epidermal nevus or dermatosis neglecta.

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Pathological changes in the umbilical region are common in calves. Among such alterations, omphalitis is included. This term is used to define inflammation and infection of the external structures of the umbilicus. According to the affected structures, it can be subclassified into omphalophlebitis, omphaloarteritis, omphalourachitis and panvasculitis. These inflammations are usually associated with bacterial infections. There are predisposing conditions that include inadequate handling such as poor hygiene and neglect of primary care. Omphalitis can affect the animal in a multisystemic way, compromising its well-being and bringing economic losses. In treatment, the use of antimicrobials does not always solve the problem. Thus, surgical treatment can be used, which has good results and should be the choice in the disease. The objective of this work is to report 30 cases of omphalitis in calves, submitted to surgical or conservative treatment. Thirty cases of omphalitis in calves treated in the routine of the Veterinary Hospital of the Paranaense University was analyzed. On physical examination, the animals presented fever, apathy, hyporexia or anorexia and increase of umbilical volume, usually with purulent secretion. Some animals had sepsis and arthritis. In animals with sepsis, hyperemia of the episcleral vessels, dehydration and severe apathy were observed. In calves with arthritis, increased joint volume, pain on palpation and lameness were observed. In animals where the owners did not authorize the surgery, treatment was instituted with sulfadoxine and flunixim meglumine. In dehydrated calves, fluid therapy was used. Animals that were surgically treated received the same clinical treatment protocol as non-operated animals. The surgical procedure was performed under general anesthesia and consisted of resection of the affected umbilical structures. Omphalophlebitis was the most common illness. The most frequent complication was sepsis. Calves treated surgically had a higher survival rate (86.66%) than those treated clinically (46.67%). The clinical signs presented by all animals converged with the literature, allowing for clinical diagnosis. Clinical examination is essential for diagnosis in omphalitis cases. Complementary methods include ultrasound, thermography and laparoscopy, which are important to identify changes in intra-abdominal umbilical structures. Accurate diagnosis of the involved structures was only possible in animals surgically, as well as alterations in organs such as the liver and bladder. There is great variability related to the umbilical structures involved, according to initial care, breeds, seasonality or even the method of conception. Unlike what is observed in the literature, in the present study, there was a higher prevalence of omphalophlebitis, demonstrating variability in relation to the umbilical structures involved. Sepsis, observed in 16.7% of cases, results from bacterial ascension of the umbilical structures. Lameness due to polyarthritis was found in 10% of animals. Meningoencephalitis was observed in 3.3%. Hepatic and retroperitoneal abscedation were observed in 6.7% and 3.3% of cases, respectively. Conservative treatment with antibiotics and local antiseptics has a limited effect on this type of condition, which was proven in the present study, since the survival rate was statistically higher in animals surgically treated.(AU)

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