Red Umbilicus as a Clinical Manifestation in a 19‐Month‐Old Girl with Typhoid Colonic Perforation

Abstract

Redness of the umbilicus is usually considered to be a reliable sign of underlying gangrenous bowel or peritonitis in tiny infants but seldom among non-neonatal patients. We report a 19-month-old girl with final diagnosis of typhoid colonic perforation who initially presented with abdominal distention and umbilical erythema on arrival at our emergency department. The redness of umbilicus diminished gradually after laparotomy. Thin abdominal wall, severe intra-abdominal soiling, and polymicrobial infection accounted for the inflammatory process spreading to the skin of the umbilicus. Because of its rarity beyond the neonatal period, prompt diagnosis depends on maintaining a high index of suspicion when the abdomen is distended and suddenly tender to palpation.

Acute abdominal pain and nephrotic syndrome: pediatric case reports and review of the literature

“…If unrecognized or untreated, the infection may complicate in a necrotizing fascitis of the abdominal wall with a high mortality rate. In the neonatal period, red umbilicus is often a troubling sign of infection, such as funisitis, omphalitis, or underlying gangrenous bowel and peritonitis like in the necrotizing enterocolitis [11,12]. But among non-neonatal patients, red umbilicus is extremely rare as a sign of peritonitis.…”

“…But among non-neonatal patients, red umbilicus is extremely rare as a sign of peritonitis. To our knowledge, this unusual presentation of red umbilicus caused by acute peritonitis in the non-neonatal period has rarely been reported [12][13][14]. In children with NS who present with abdominal pain, spontaneous bacterial peritonitis should be considered as the most important differential diagnosis [10], but it is not the only cause, as shown in Table 2.…”

The Red Umbilicus Sign: What Adults Should Learn From Children?

“…Lin and Chang in 2007, had described this sign in a non-neonatal patient [1]. Adults with complicated umbilical hernia (strangulation or ulceration and rupture), especially in the setting of refractory ascites and cirrhosis can present with sudden skin changes overlying the hernia.…”

Feasibility of Emergency Laparoscopic Colectomy for Children with Acute Colonic Perforations and Fibropurulent Peritonitis

“…Typhoid fever and nontyphoidal salmonellosis are the major public health problems in developing countries. Intestinal perforation secondary to salmonella infection is a life‐threatening complication and is usually located in the distal ileum [14, 15], whereas colonic perforation with sparing of the small intestine has been illustrated in a few case series [13, 17]. Laparoscopic surgery for typhoid ileal perforations has been reported in adulthood and would be beneficial in terms of limiting sepsis‐related wound complications [14, 15].…”