Umbilical hernia

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Overview
Umbilical hernia is a congenital malformation, especially common in infants of African descent, and more frequent in boys.

Presentation
A hernia is present at the site of the umbilicus (commonly called a navel, or belly button) in the newborn; although sometimes quite large, these hernias tend to resolve without any treatment by around the age of 5 years. Obstruction and strangulation of the hernia is rare because the underlying defect in the abdominal wall is larger than in an inguinal hernia of the newborn.

Babies are prone to this malformation because of the process during fetal development by which the abdominal organs form outside the abdominal cavity, later returning into it through an opening which will become the umbilicus.

Differential diagnosis
Importantly this type of hernia must be distinguished from a para-umbilical hernia which occurs in adults and involves a defect in the midline near to but not through the umbilicus, and from omphalocele.

Treatment
When the orifice is small (< 1 or 2cm), 90% closes within 3 years (some sources state 85% of all umbilical hernias, regardless of size ), and if these hernias are asymptomatic, reducible, and don't enlarge, no surgery is needed (and in other cases it must be considered). However, in some communities mothers routinely push the small bulge back in and tape a coin over the palpable hernia hole until closure occurs. This practice is not medically recommended as there is a small risk of trapping a loop of bowel under part of the coin resulting in a small area of ischemic bowel. The use of bandages or other articles to continuously reduce the hernia is not evidence-based.

In adults
Umbilical hernias in adults are largely acquired, and more frequent in pregnant women. Abnormal decussation of fibers at the linea alba may contribute.

It is theorized that cutting the umbilical at birth is a cause of umbilical hernia. Allowing the umbilical cord to fall off naturally may eliminate chance of umbilical hernia in infants.

Umbilical hernia has been reported as a complication of a transjugular intrahepatic portosystemic shunt.

An umbilical hernia can be fixed 2 different ways. The surgeon can opt to stitch the walls of the abdominal or he/she can pleace mesh over the opening and stitch it to the abdominal walls. The later is of a stronger hold and is commonly used for larger tears in the abdominal wall.

Pregnant woman are suseptible to hernias. There are times that the uterus may block the bowels from coming through the opening, but these cases are rather rare. 6 weeks after the baby is born, most surgeons will repair the hernia.

(Images courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, California)

Information for patients for pediatric umbilical hernia
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