UMBILICAL HERNIA
 
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UMBILICAL HERNIA

 

DEFINITION:

A condition caused by a small defect in the periumbilical musculature of the anterior abdominal wall resulting in protrusion of the umbilicus.

EPIDEMIOLOGY:

  • incidence: ?
  • age of onset:
    • at birth or during the first year of life
  • risk factors:
    • blacks > whites
    • low birth weight
    • hypothyroidism
    • chromosomal anomalies (i.e., Trisomy 13)
    • Mucopolysaccharidoses (i.e., Hurler Syndrome)
    • Beckwith-Wiedemann Syndrome
    • Williams Syndrome

PATHOGENESIS:

1. Background

  • in normal embryogenesis, the intestines exit the abdominal cavity, return, rotate, then become fixed to the posterior abdominal wall
  • an umbilical hernia results from the failure of this process and due to an imperfect closure or weakness of the umbilical ring, a small portion of the intestine remains in the umbilical coelom producing a small sac protruding up through the base of the umbilical cord
  • this sac (hernia) may contain omentum or portions of the small intestine

CLINICAL FEATURES:

1. Gastrointestinal Manifestations

1. Protuberant Umbilicus

  • usually varies from 1-5 cm in diameter
  • increases in size with any process which increases the intraabdominal pressure (i.e., crying, coughing, straining)
  • easily reduced when the infant is relaxed
  • is soft, non-tender, and covered by normal skin
  • may be associated with diastasis recti
  • complications are rare (see below)

2. Complications

  • incarceration (irreducible umbilical hernia)
  • strangulation of the intestine within the hernia
  • perforation of the hernia

INVESTIGATIONS:

1. Abdominal Ultrasound

  • usually not indicated unless complications

MANAGEMENT:

1. Supportive

  • observe as most hernias close spontaneously before 5 years of age
  • most hernias that appear before 6 months of age disappear by 1 year of age
  • "strapping" or "coining" are ineffective therapies

2. Surgery

  • indications for surgery:
    • complications (incarceration, strangulation, perforation)
    • if the hernia persists to 3-4 years of age
    • a large hernia (defects larger than 2 cm in diameter are less likely to close spontaneously)
    • the hernia becomes progressively larger after 1-2 years of age
    • cosmetic reasons

ADDITIONAL REFERENCES:

1. Rudolph, A.M., Rudolph's Pediatrics. 19th Edition. p.173, 1042, (1991).

 

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