What is the role of surgery in the treatment of omphalitis?

Updated: May 20, 2019
  • Author: Patrick G Gallagher, MD; Chief Editor: Santina A Zanelli, MD  more...
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Answer

Management of necrotizing fasciitis and myonecrosis involves early and complete surgical debridement of the affected tissue and muscle. [43, 49] Consider the following:

  • Although the extent of debridement depends on the viability of tissue and muscle, which is determined at the time of surgery, excision of preperitoneal tissue (including the umbilicus, umbilical vessels, and urachal remnant) is critically important in the eradication of the infection.

  • These tissues can harbor invasive bacteria and provide a route for progressive spread of infection after less extensive debridement.

  • Delay in diagnosis or surgery allows progression and spread of necrosis, leading to extensive tissue loss and worsening systemic toxicity.

  • Several surgical procedures may be required before all nonviable tissue is removed.

Routine postsurgical follow-up care is indicated. Infants developing portal vein thrombosis require follow-up care for complications associated with portal hypertension.


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