Belly Button Infection: Omphalitis
A belly button infection is medically known as omphalitis, which is an inflammation and infection of the umbilicus (navel) and surrounding tissues.
Clinical Presentation and Diagnosis
Omphalitis typically presents with:
- Erythema (redness) and induration (hardening) around the umbilical area
- Tenderness or pain at the umbilicus
- Purulent discharge from the umbilical stump
- Possible fever and signs of systemic illness in severe cases 1
- Edema (swelling) of the surrounding tissue 2
Classification of Peritoneal Infections
Omphalitis should be understood within the broader context of intra-abdominal infections:
- Primary peritonitis: Diffuse bacterial infection without loss of gastrointestinal tract integrity, typically seen in cirrhotic patients with ascites or peritoneal dialysis patients 3
- Secondary peritonitis: Acute peritoneal infection from loss of integrity of the gastrointestinal tract 3
- Tertiary peritonitis: Recurrent infection following primary or secondary peritonitis 3
Omphalitis itself is typically a localized infection but can potentially progress to more serious complications if left untreated.
Diagnostic Approach
When evaluating suspected omphalitis:
- Physical examination to assess for characteristic signs of umbilical inflammation
- Ultrasound may be used as first-line imaging, especially in resource-limited settings 3
- CT scan with intravenous contrast may be necessary if complications are suspected 3
- Culture of any purulent discharge to identify causative organisms
Treatment
Treatment of omphalitis primarily consists of appropriate antibiotic therapy, with surgical intervention reserved for complications or specific underlying conditions 1.
Antibiotic Therapy
- Antibiotics should cover both aerobic gram-negative organisms and anaerobic organisms 3
- Initial empiric therapy should be broad-spectrum until culture results are available
- Common regimens include:
- Second or third-generation cephalosporin plus metronidazole
- Amoxicillin-clavulanate
- Fluoroquinolones (such as ciprofloxacin) plus metronidazole for Pseudomonas, Enterobacter, Serratia, and Citrobacter species 3
Surgical Management
Surgical intervention is indicated for:
- Presence of abscess requiring drainage
- Underlying anatomical abnormalities (such as urachal remnants)
- Development of complications like necrotizing fasciitis or peritonitis 4
Complications
Potential complications of untreated omphalitis include:
- Umbilical abscess formation 2
- Necrotizing fasciitis involving surrounding tissues 4
- Peritonitis and intra-abdominal abscesses 4
- Hepatic abscesses 4
- Evisceration through the umbilical cicatrix (in neonates) 4
- Adhesive intestinal obstruction 4
Special Considerations
- In adults, recurrent umbilical infections may be associated with foreign bodies or accumulated debris (omphaliths or "belly button bezoars") 5
- Underlying urachal abnormalities should be considered in patients with persistent umbilical drainage 2, 1
- Prompt recognition and treatment are essential to prevent progression to more serious complications 6
Follow-up
- Patients should be monitored for resolution of symptoms
- Complete the full course of prescribed antibiotics
- Surgical follow-up is necessary if intervention was required or if underlying anatomical abnormalities were identified