Diagnostic accuracy of abdominal ultrasound to detect pathology that needs surgical exploration in children with umbilical discharge

Abstract

Background: Umbilical discharge is common in children and mostly attributed to infection or granuloma. However, an underlying congenital abnormality warranting surgery might also be present. Ultrasound is the imaging modality of choice to diagnose the presence of a congenital abnormality. The aim of this study is to investigate diagnostic accuracy of the ultrasound to detect pathology requiring surgical excision. Methods: All patients ≤18 years with umbilical discharge from January 2008 to September 2019 were retrospectively included. Diagnostic accuracy, i.e., sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR−), were calculated. Results: Eighty-one patients were included and 56 were operated. The ultrasound was false positive in 10 patients and false negative in 13 patients. The sensitivity of ultrasound was 71.1% (95% CI 55.7-83.6), specificity 72.2% (54.8-85.8), PPV 76.2% (64.7-84.8), NPV 66.7% (54.8-76.8), LR+ 2.6 (1.5-4.5) and LR− 0.40 (0.2-0.7). Conclusions: This study shows that the diagnostic accuracy of ultrasound for detecting underlying congenital abnormalities warranting surgery for umbilical discharge in the pediatric population is low, even with experienced pediatric radiologists. Therefore, the role of the ultrasound in the diagnostic workup and value in clinical decision making is limited. Type of study: Study of diagnostic test.

Umbilical nodule present since birth

“…When clinical or radiographic evaluation is concerning, a mini-laparotomy or laparoscopy is typically performed. 1,[3][4][5][6]9 In our case, the lesion has not recurred following shave excision.…”

“…In the presence of any of the concerning features listed above, the authors recommend an ultrasound be performed prior to biopsy. If the ultrasound is non‐diagnostic or identifies a concerning feature then CT or MRI should be obtained 1,9 . Some authors have questioned the sensitivity of imaging in identifying OMD remnants and recommend routine surgical exploration 3 .…”

“…Neither the true rate of co‐occurrence of umbilical polyps with OMD or heterotopic gastric mucosa nor percentage of umbilical polyps that develop complications is known. When clinical or radiographic evaluation is concerning, a mini‐laparotomy or laparoscopy is typically performed 1,3–6,9 …”

“…If the ultrasound is non-diagnostic or identifies a concerning feature then CT or MRI should be obtained. 1,9 Some authors have questioned the sensitivity of imaging in identifying OMD remnants and recommend routine surgical exploration. 3 However, in one report of 13 patients with draining umbilical polyps, six underwent surgical exploration without OMD remnant identified; seven did not have surgery and remained asymptomatic after mean of 5.8 years.…”

Current management strategies of urachal anomalies in pediatric patients: A scoping review

“…contained elements of a prospective surgical study where 8 patients were randomly assigned to receive surgical treatment (1). Three of the studies (9.4%) classified as retrospective chart reviews discussed diagnostic methods and reviewed imaging studies used in diagnosis without primarily focusing on the treatment of UAs (8,25,31).…”