Umbilical Hernias
Summary
- uncomplicated umbilical hernias may be safely observed in the first few years of life, with spontaneous regression occurring in most cases
- serious complications are rare
Introduction
Umbilical hernias are common in the neonatal period and represent a central fascial gap beneath the umbilicus through which abdominal contents may protrude, covered by skin. This gap is a consequence of delayed contraction of the encircling fibromuscular umbilical ring.
They are more common in
- preterm infants
- Down syndrome
- increased intra-abdominal pressure (eg ascites)
- congenital hypothyroidism
Although the hernia may be prominent with straining or crying it should be easily reducible. Incarceration, strangulation and evisceration are rare complications.
Differential Diagnosis
- paraumbilical hernias (usually sited just above the umbilicus) require surgical review
- exomphalos (herniation of viscera into the base of the umbilical cord covered by fused amniotic membrane and peritoneum) requires urgent surgical referral
- epigastric hernia (presents as a tender lump in the midline of the epigastrium)
Investigation
No investigations are required in uncomplicated cases.
Management
Most children with an umbilical hernia require no intervention. Although some may initially increase in size over the first few months of life over 90% will have closed by 2 years of age. Surgery beyond this age is usually on cosmetic grounds although the risk of incarceration is increased in adulthood. Dressings to cover the hernia (eg coins, strapping) are ineffectual and may traumatise surrounding skin.
References
Avery, G.B., Fletcher, M.A., and MacDonald, M.G. (editors). Neonatology: Pathophysiology and Management of the Newborn. 5th edition. Lippincott, Williams & Wilkins. 1999.
Hutson, J.M., Woodward, A.A., Beasley, S.W. (editors). Jones’ Clinical Paediatric Surgery, Diagnosis and Management. 5th edition. Blackwell Science Asia. 1999.
Ashcraft, K.W., Murphy, J.P., Sharp, R.J., Sigalet, D.L., Snyder, C.L. (editors). Pediatric Surgery. 3rd edition. W.B. Saunders Company. 2000.
Updated 04/06/2009
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