These fibroblasts, or connective tissue cells, are responsible for the production of collagen and additional fibers, resulting in the excess tissue mass found in the granuloma. Additional histological studies reveal an increase of cell division of vascular endothelial cells. These cells line our blood vessels and are further responsible for the growth and development of tissue and the formation of new blood vessels within the granuloma. Pathophysiology
Inflammatory saprophytic microorganisms, involved with decomposition, may delay the healing process, and can lead to overproduction of fibroblasts that are involved in normal skin restoration. These microorganisms can interfere with the skin’s normal flora, and lead to increased pathogenic inflammation that leads to delayed epithelialization and the formation of granulomas with excessive blood vessels, fibroblasts, and mucus. Signs and symptoms
Umbilical granulomas appear as round, pink lumps found at the base of the umbilicus after the removal of the umbilical cord. It appears small, pink/red, and moist due to cord separation. They are usually 1-10 mm in size, however grow in size if they are not treated. Umbilical granulomas are also painless since they do not contain nerve fibers. In some cases, they may contain an odorless discharge, or may be covered in a clear mucus. The surrounding skin of the infants umbilicus site will appear normal. Umbilical granulomas can become entry points for infectious agents. Symptoms such as edema, redness around the umbilical site, pain or discomfort when the area is touched, accompanied by a fever and purulent discharge, may indicate sepsis or a serious infection at the umbilicus site.
In the treatment of umbilical granulomas, silver nitrate is applied to the umbilical site to burn off the excess tissue. The absence of nerve endings within the granuloma make this a painless treatment for the newborn. While painless, contact of silver nitrate to the adjacent, healthy, normal tissue may result in burns. Silver nitrate application to the infected site should not exceed three applications with an interval of 3-4 days. In this event, alternative treatments should be considered Following treatment with silver nitrate, the granuloma is expected to shrink and resolve within 7 days. Double-ligature treatment
In cases with deeply located umbilical granulomas, the double-ligature technique can be utilized to ligate the base of the granuloma. The procedure involves prepping and sterilizing the umbilical area with iodine solution, placing a silk suture around the base of the lesion to keep in place, and finally placing a more exact ligature around the granuloma. Much like the normal process of umbilical cord residue healing, the ligated granuloma will necrose due to lack of blood supply and will fall off naturally within 1 to 2 weeks. Minor complications of this technique include minimal bleeding and possibly requiring more ligatures than the original double ligation. Cryocautery
Cryocautery can be utilized to freeze the umbilical granuloma by using cryogenic nitrous oxide along with other equipment. During cryocautery procedures, the umbilical site is first cleaned. The physician will then hold a cyroprobe with nitrous oxide as a refrigerant directly to the granuloma for 3 minutes.