UMBILICAL HERNIA
Last Updated : 1/6/2011
Vivek M. Rege
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This is a problem noticed right in infancy after the umbilical cord had dried and fallen off. This is a skin swelling at the belly button that protrudes when the child cries or strains or coughs. The amount of projection of the

swelling

varies from child to child. In some, it may be just a small protrusion; in others it may be a large rounded swelling bulging out when the baby cries. This may hardly be visible when the child is quiet and or sleeping. Normally, the abdominal muscles converge and fuse at the umbilicus during the formation stage, however, in some cases, there remains a gap where the muscles do not close and through this gap the inner intestines come up and bulge under the skin, giving rise to the Umbilical Hernia. The bulge of contents can easily be pushed back and reduced into the abdominal cavity.

Figure: Umbilical Hernia


In contrast to an inguinal hernia, the

complication incidence

is very low, also, the gap in the muscles usually closes with time and the hernia disappears on its own. The treatment of this condition is essentially conservative - observation allowing the child to grow up and see if it disappears. There is absolutely no role for putting a coin and tying a cloth over it to reduce the hernia - in fact, it may cause complications. During the period of observation, care needs to be taken to see that the common causes for straining like coughing, constipation, straining to pass urine are kept at a minimum with or without the help of medicines as required. Operation and closure of the defect is required only if the hernia persists after the age of 3 years, or, if the child has an episode of complication during the period of observation like: irreducibility, intestinal obstruction, abdominal distension with vomiting, red shiny painful skin over the swelling. Surgery is always done under anesthesia, and the defect in the muscles is defined and the edges of the muscles are brought together with sutures to close the defect. The child needs to stay in the hospital for 2 days and the healing is complete in 8 days.

At times, there may be a fleshy red swelling seen in the hollow of the umbilicus that persists after the cord has fallen off. It may bleed on touch, or may stain the clothes coming in contact with it. This needs to be shown to a Pediatric Surgeon. This is most likely to be an Umbilical Polyp and the therapy is to tie it at the base with a stitch so that it falls off and there is no bleeding. Alternatively, it may be an Umbilical Granuloma that responds well to local application of dry salt or Silver Nitrate but may take a few weeks to heal and get dry.



Contributor Information and Disclosures

Vivek M. Rege
Pediatric Surgeon & Pediatric Urologist, B J Wadia Hospital For Children, Hurkisondas Hospital, Wockhardt Hospital, Mumbai, India


First Created : 1/17/2001

References

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