An umbilical hernia is a protrusion, bulge, or projection of an organ or part of an organ through the body wall such as the abdominal wall. When the hole around your baby’s umbilical cord doesn’t close right, it can turn into an umbilical hernia. Most kids are fine without treatment. A hernia is a protrusion, bulge, or projection of an organ or part of an organ through the body wall that normally contains it. Abdominal wall.
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Coste ; Steve S. Coste 1 ; Steve S. An umbilical hernia is a protrusion, bulge, or projection of an organ or part of an organ through the body wall such as the abdominal wall. The cause of a true umbilical hernia congenital type is a failed closure of the umbilical ring during gestation that ultimately results in a central defect in the linea alba.
ISRCTN – ISRCTN Hernia Umbilicalis Mesh versus Primary suture
This defect is prevalent in infants and young children. Skin and subcutaneous tissue only cover an umbilical hernia itself, but the underlying fascial defect allows protrusion of abdominal contents such as omentum or possibly intestines.
Umbilical hernias are smaller than one centimeter in size that present at the time of birth usually will close spontaneously by four to five years of life. In some cases, the umbilical hernia is large enough that the protrusion is blighting and disconcerting to both the child and the family, which would then warrant early repair.
Umbilical hernias in adults are usually acquired and are more common in women or patients with increased intra-abdominal pressure as in pregnancy, obesity, ascites, or hernua abdominal distention. Umbilical hernias heria are associated with several congenital syndromes and medical conditions such as hypothyroidism, mucopolysaccharidosis, Down syndrome, Beckwith—Wiedemann syndrome, and exomphalos—macroglossia syndrome. During fetal development, the abdominal wall is formed by four separate embryologic folds: Each fold is composed of somatic and splanchnic layers.
The folds then develop towards the anterior center portion of the coelomic cavity i. These structures are enclosed by the outer layer of amnion. The entire unit, itself, comprises the umbilical cord.
During the time between fifth and tenth gernia of gestation, the intestinal tract undergoes rapid growth with protrusion of the abdominal content outside the abdominal cavity, usually within the proximal portion of the umbilical cord. This is followed by a gradual re-entry of the abdominal cavity and then the ultimate narrowing of the umbilical ring which completes the process of abdominal wall formation as fetal development concludes.
Failures of each fold will lead to different congenital disabilities at birth. For example, failure of the cephalic fold to close will usually result in sternal defects i. Disruption of the central migration of the lateral folds will lead to a defect called omphalocele. Omphalocele is a condition that leads to the inability of the abdominal contents to be reduced back into the abdomen, resulting in a large hernia covered by a peritoneal sac.
In comparison hednia gastroschisis, thought initially to be herbia variant of omphalocele, this possibly results from isolated intrauterine vascular insult leading to an abdominal wall defect to the right of the umbilical cord. Parents or physicians typically note them shortly after birth. All families of babies with an umbilical hernia should be counseled about signs of incarceration, which is rare in umbilical hernias and more common in smaller 1 cm hernix less than larger defects.
Incarceration presents with abdominal pain, bilious emesis, and a tender, hard mass protruding from the umbilicus. This constellation of symptoms mandates immediate exploration and repair of a hernia to avoid strangulation. More commonly, the child is asymptomatic, and treatment is governed by the size of the defect, the age of the patient, and the concerns that the child and family have regarding the cosmetic appearance of the abdomen.
Umbiilicalis defects close spontaneously by the age of two. When the defect is small and spontaneous, closure is likely, and most surgeons will delay surgical correction until five years of age. Adults who are symptomatic typically present with a large hernia loss of domainskin color changes consistent with incarceration, thinning of the overlying skin, or uncontrollable ascites and should have a hernia repair.
Spontaneous rupture of umbilical hernias in patients with ascites can result in peritonitis and death. Relative surgical indications take into account the two factors most often associated with a decreased likelihood of spontaneous closure: Some surgeons also recommend elective repair when there is a need for general anesthesia during concurrent minor otolaryngologic, orthopedic, or other procedures.
Surgical repair for an uncomplicated umbilical hernia is done under general anesthesia as an outpatient procedure. After local anesthesia, a small curvilinear incision is made into the skin crease of the umbilicus, and the sac is dissected free from the overlying skin as well the fascial defect to ensure not abdominal content are present prior repair of the fascial defects.
The fascial defect is repaired with absorbable, interrupted sutures that are typically placed in a transverse plane. The skin is closed using subcuticular sutures, either monocryl or vicryl. The postoperative recovery is usually uneventful. Recurrence is uncommon, but often seen in children with elevated intra-abdominal pressures. In adults, small defects are closed primarily after separation of the sac from the overlying umbilicus and surrounding fascia. Defects greater than 3 cm are closed using prosthetic mesh.
Currently, no prospective data have conclusively found clear advantages of one technique over another.
Über Hernia umbilicalis.
Options for mesh implantation include bridging the defect and placing a preperitoneal underlay of mesh reinforced with suture repair. The laparoscopic technique requires general anesthesia and is reserved for large defects or recurrent umbilical umbilcialis. For most patients, the prognosis is excellent. However, recurrences have been reported in adults chiefly herni to faulty technique.
Because these hernias have a high risk of incarceration, surgery is recommended in all patients. A dietary consult should be made to educate the patient on a healthy diet.
Once the healing is done, the patient should be encouraged to join a physical therapy program and lose weight.
This is vital in preventing a recurrence. To access free multiple choice questions on this topic, click here. This book is distributed under the terms of the Creative Commons Attribution 4. Turn recording back on. National Center for Biotechnology InformationU. StatPearls Publishing; Jan. Show details Ummbilicalis Island FL: StatPearls Publishing ; Jan.
Hernia, Umbilical Anouchka H. Author Information Authors Anouchka H. Introduction An umbilical hernia is a umbilicallis, bulge, or projection of an organ or part of an organ through the body wall such as the abdominal wall. Etiology The cause of a true umbilical hernia congenital type is a failed closure of the umbilical ring during gestation that ultimately results in a central defect hernis the linea alba. Pathophysiology During fetal development, the abdominal wall is formed by four separate embryologic folds: The two umbilical arteries.
Pearls and Other Issues For most patients, the prognosis is excellent. Questions To access free multiple choice questions on this topic, click here.
The Complete Two-year Follow-up. Transumbilical repair of umbilical hernia in children: The covert scar approach. Umbilical Hernia with Evisceration. Two Cases and a Review of the Literature. Umbilical Hernia Repair and Pregnancy: PMC ] [ PubMed: Pathak S, Poston GJ. It is highly unlikely that the development of an abdominal wall hernia can be umbiilcalis to a single strenuous event.
Ann R Coll Surg Engl. Trocar site post incisional hernia: Pan Afr Med J. Management of asymptomatic pediatric umbilical hernias: Day case hernia repair: Mechanical properties of the abdominal wall and biomaterials utilized for hernia repair. J Mech Behav Biomed Mater. Long-term follow-up after umbilical hernia repair: Overview of Approaches and Review of Literature.
Safety and effectiveness of umbilical hernia repair in patients with cirrhosis. Similar articles in PubMed. Review herniw hernia in children]. J Clin Diagn Res. Epub Mar 1.
Umbilical hernia repair in pregnant patients: Epub Jul Acquired umbilical hernias in four captive hernai bears Ursus maritimus. J Zoo Wildl Med. Review Abdominal hernias in pregnancy. J Umbilifalis Gynaecol Res. Clear Turn Off Turn On. Hernia, Umbilical – StatPearls.