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Umbilical Hernia

An umbilical hernia is a type of abdominal wall hernia which may occur in children and adults.


Presentation

In the newborn, a hernia is usually present at the site of the umbilicus. A small sac usually protrudes through the umbilicus as the child cries, coughs or strains. The bulge may disappear spontaneously when the baby is calm. They can vary in size and are rarely bigger than about 2.5 cm. In childhood, the umbilical hernias are usually painless. Sometimes the intestine gets trapped within the umbilical hernia. This is referred to as an incarcerated hernia and the child usually has a severe pain with red and firm bulge through the umbilicus [5] [6].

In adults, umbilical hernia is more common in obese women and between 35 to 50 years of age. The hernia appears as small, round or oval shaped swelling, more prominent on coughing. These hernia may become irreducible because of the formation of omental adhesions [7]. Large umbilical hernias cause dragging pain because of their weight. Gastrointestinal symptoms such as abdominal pain and constipation are common in these patients. Often there are transient attacks of intestinal colic because of partial intestinal obstruction.

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Workup

  • History: The patients with umbilical hernia usually complain of umbilical bulge with raised intraabdominal pressure when the individual coughs or strains the abdomen.
  • General physical examination: An umbilical hernia can be seen or felt as a bulge through the umbilicus when the patient coughs. There may be discoloration of the skin at the site of hernia.
  • Laboratory tests: An umbilical hernia is diagnosed on the basis of history and physical examination. Sometimes imaging studies such as abdominal ultrasound, CT scan or X-ray may be necessary to rule out complications.

Treatment

Umbilical hernias usually close on their own in infants and young children within the first three years of life. If the hernia persists over 5 years of age or if there is an episode of incarceration or if the hernia is very large, surgical repair may be recommended [8].

Surgical repair is usually done by the small incision made at the base of the umbilicus. Most children are able to return home within a few hours after surgery. Taping a coin down over the bulge does not usually help, this may rather lead to infections and complications.

For adults, surgery alone is the treatment of choice to avoid possible complications, especially if the umbilical hernia gets bigger or becomes painful due to intestinal strangulation within the hernia. The two surgical treatment options available to correct an umbilical hernia are laparoscopic hernia repair and open hernia repair [9] [10].

Prognosis

An umbilical hernia can be treated completely by surgical repair in most of the cases. There is always a chance that the hernia can come back [1]. However, for healthy patients, the risk of recurrence is usually low. If left untreated, umbilical hernia can expand and result into serious complications such as strangulated hernia, rupture of the hernial sac, infections, pneumonia and pulmonary edema [2] [3] [4].

Etiology

Umbilical hernias are most common in low birth weight babies and premature infants. For adults, being overweight or having multiple pregnancies may increase the risk of developing an umbilical hernia. This type of hernia is more common in women in their fifties and sixties.

Moreover, directly increased intraabdominal pressure caused by a history of prolonged cough, heavy weightlifting, previous abdominal surgery, ascites, straining with urination or defecation, and chronic obstructive pulmonary disease may also increase the risk for the development of umbilical hernia.

Epidemiology

Umbilical hernias comprise 10% of abdominal wall hernias. Of the half million hernia operations performed in the United States every year, about 14% are umbilical hernia repairs. The female to male ratio of umbilical hernia is 1.7:1. Over 95% of these hernia close spontaneously in the first three years of life. Persistence after third birthday is an indication for elective repair.

As with all abdominal hernias, the persistence of umbilical hernia increases with age. They are equally common in men and women, and umbilical hernias are more common in individuals of African ancestry.

Sex distribution
Age distribution

Pathophysiology

During pregnancy, the umbilical cord passes through a small opening in the baby’s abdominal muscles, connecting mother to baby. This opening is known as the umbilical ring. The ring usually closes before the baby is born. If due to any pathology, the muscles do not join completely in the midline of the abdomen, the ring does not close and the weakness in the abdominal wall results in the protrusion of abdominal contents through umbilicus at birth or later in life. This results into infantile umbilical hernia.

In adults, umbilical hernia is usually secondary to raised intraabdominal pressure caused by obesity or fluid in the abdomen. The raised intraabdominal pressure pushes the contents out of the weak abdominal wall.

Prevention

An umbilical hernia can be prevented by controlling weight, using effective lifting techniques, reducing pressure while coughing or sneezing and preventing straining during bowel movements. Pregnant females have an increased risk of developing umbilical hernia and therefore they should reduce the risk by maintaining their weight and taking preventive measures. Patients with chronic obstructive lung disease should also get proper treatment to avoid serious complications.

Summary

An umbilical hernia is an abnormal protrusion of the abdominal contents through a weakness in the wall of the abdomen. It takes with it all the linings of the abdomen. It can be seen or felt at the umbilicus. Umbilical hernia is the most common form of all ventral hernias. True umbilical hernias occur in infants in which a small sac protrudes through the umbilicus particularly when the child cries, but is easily reduced. This type of hernia occurs in adult life as well and protrudes through the umbilical scar usually secondary to raised intra-abdominal pressure e.g. ascites, obesity or multiple pregnancies. Boys and girls are affected equally. Untreated cases of umbilical hernia can cause severe complications.

Patient Information

An umbilical hernia is an abnormal bulge present at the umbilicus, the belly button. The condition is more common in infants and young children than adults. The hernia usually is not painful and it often resolves on its own without treatment. Preventive measures such as controlling weight and reducing intraabdominal pressure can reduce the risk of umbilical hernia.

References

Article

  1. Halm JA, Heisterkamp J, Veen HF, Weidema WF. Long-term follow-up after umbilical hernia repair: are there risk factors for recurrence after simple and mesh repair. Hernia : the journal of hernias and abdominal wall surgery. Dec 2005;9(4):334-337.
  2. Haworth JC. Strangulation of umbilical hernia in children. British medical journal. Apr 13 1957;1(5023):869.
  3. Stranger SL. Spontaneous rupture of umbilical hernia in an infant. Postgraduate medical journal. Jan 1956;32(363):39.
  4. Schairer AE, Cox LM, Keeley JL. Spontaneous perforation of umbilical hernia in cirrhosis of the liver. American journal of surgery. Jul 1963;106:94-98.
  5. Vrsansky P, Bourdelat D. Incarcerated umbilical hernia in children. Pediatric surgery international. 1997;12(1):61-62.
  6. Chatterjee H, Bhat SM. Incarcerated umbilical hernia in children. Journal of the Indian Medical Association. Aug 1986;84(8):238-239.
  7. Bieber EJ, Levrant S. The Risk of Anterior Abdominal Wall Adhesions in Patients with Previous Umbilical Hernia Repair. The Journal of the American Association of Gynecologic Laparoscopists. Aug 1994;1(4, Part 2):S4.
  8. Burattini MF, Bussotti C, Scalercio V, et al. [Surgical treatment of umbilical hernia in children. Our experience]. Minerva chirurgica. Jun 2004;59(3):277-282.
  9. Gonzalez R, Mason E, Duncan T, Wilson R, Ramshaw BJ. Laparoscopic versus open umbilical hernia repair. JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons. Oct-Dec 2003;7(4):323-328.
  10. Ma B, Tian W, Chen L, Liu PF. [Laparoscopic tension-free repair of umbilical hernia]. Zhonghua wai ke za zhi [Chinese journal of surgery]. Mar 1 2010;48(5):345-347.

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Last updated: 2018-06-22 08:33