Umbilical cord anomalies: antenatal USG findings & postnatal
Umbilical cord anomalies are rare. The differential diagnosis for a cystic structure around the umbilical cord and its insertion include pseudocyst, omphalomesenteric duct cyst, haemangioma, omphalocele or anterior abdominal wall defects.

Although cord anomalies can be detected through antenatal ultrasound scans (US), very often a definitive diagnosis cannot be made. This may affect the management of the infant at birth. In cases where antenatal US was not diagnostic, current evidence supports the use of MRI to help in making an accurate diagnosis.

Published in BMJ, the authors report two cases of umbilical cord anomalies. The first case was diagnosed in antenatal US as an omphalocele, but was found to be an allantoic cyst with hamartoma on postnatal diagnosis. The second case was not detected on antenatal US, and was diagnosed postnatally as a small omphalocele with vitellointestinal duct remnants.

Outcome and follow-up
Case 1: This infant was reviewed in the neonatal follow-up clinic at 1 year of age. His growth and development are appropriate for age.

Case 2: He had moderate to severe gastro-oesophageal reflux disease at 2 months of age, needing antireflux medications and modified formula milk. He had his medical check-up at 5 months of age. His growth and development are progressing well.

Learning points:-
• Umbilical cord anomalies, which result from failure of obliteration of the vitellointestinal duct, though rare, are associated with complications in newborn infants.

• Some of these anomalies can be detected on prenatal ultrasound scan, but very often a definitive diagnosis cannot be made through a prenatal scan.

• It is important for the neonatologist to perform a thorough history and physical examination postdelivery, for an early diagnosis of an umbilical cord anomaly. A multidisciplinary team approach including the surgeon and geneticist to decide on appropriate investigations to delineate the lesion will be rewarding.

• Prompt surgical management of an umbilical cord anomaly is associated with good prognosis.

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