Umbilical hernia presents as a bulge at the site of the umbilicus, results from incomplete closure of the fascia of the umbilical ring, through which intraabdominal contents may protrude.
- Umbilical hernias are common, occurring in 10% to 20% of all children.
- Commonly seen in premature and low birth weight babies.
- Common finding during routine well-baby visits for the first few months of life and it is major concern for parents.
Clinical features
| Symptoms | Signs |
| Painless swelling over umblicus Increase in size while crying Can be reduced after manipulation | Measure the size of hernial defect Determine reducibility Is there any sign of incarceration or stragulation |
Note: Patient present with abdominal pain, nausea, and vomiting when there is strangulation of hernia.
Differential Diagnosis and Complications
D/D:
- Diastasis recti: Separation of the abdominal muscles along the midline. Not a true hernia and does not contain any tissue from inside the abdomen.
- Omphalocele: Birth defect where some of the abdominal organs protrude through an opening in the abdominal wall near the umbilicus. It is covered by a thin membrane and requires surgical repair soon after birth.
- Gastroschisis: Birth defect where some of the abdominal organs protrude through a defect in the abdominal wall next to the umbilicus. It is not covered by any membrane and requires surgical repair soon after birth.
Complications:
- Incarceration or strangulation
- Cosmetic concerns: Some parents or children may be bothered by the appearance of the hernia and may seek surgical correction for aesthetic reasons.
- 2% Recurrence after surgery
Investigation
No tests are recommended, a thorough physical exam is sufficient to make the diagnosis.
Umbilical hernias are more common in common autosomal trisomies (such as Trisomy 21 and 18), metabolic disorders (such as hypothyroidism and mucopolysaccharidoses), and some dysmorphic syndromes (such as Beckwith-Wiedemann syndrome and Marfan syndrome).
Note: It is important to distinguish healthy patients with an innocent finding of an isolated umbilical hernia, from patients with an umbilical hernia and other syndromic features.
Thyroid Function Test can be sent to rule out hypothyroidism, if mother also have thyroid disorder.
Management
- Many umbilical hernias close within 2 years.
- Expectant management of asymptomatic umbilical hernias until age 4-5years is both safe and the standard care.
The management of umbilical hernias depends on several factors such as:
- The age of the child
- The size of the hernia
- The presence of symptoms or complications
- The preference of the parents or child
Surgery:
- Complications of the hernia which includes incarceration, strangulation, or rupture
- Defect of 1.5 cm or more in children over the age of 2 years
Procedure: Umbilical hernia repair is a day procedure done under general anesthesia, with a non-absorbable suture obliterating the umbilical ring through an infra-umbilical incision. Umbilicoplasty may be performed to improve cosmetic results in people who have a large umbilical hernia.
Note: Strapping, with or without a coin, is not a recommended treatment for umbilical hernias. There’s no scientific evidence to support its effectiveness. In fact, it can cause discomfort to baby and skin erosion or infection.
Refer baby to pediatric surgeon if there is sign of strangulation or need immediate surgical intervention.
Reference
: Umbilical hernia – Symptoms & causes – Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/umbilical-hernia/symptoms-causes/syc-20378685
: Umbilical Hernia | Causes, Symptoms, Diagnosis & Treatment. Retrieved from https://www.cincinnatichildrens.org/health/u/umbilical-hernia
: Hernia in Children and Babies | Johns Hopkins Medicine. Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/hernia-in-children-and-babies
: Umbilical Hernia – Leeds Teaching Hospitals NHS Trust. Retrieved from https://www.leedsth.nhs.uk/a-z-of-services/childrens-surgery/childrens-day-surgery/about-your-procedure/umbilical-hernia/