UMBILICAL HERNIA
Last Updated : 1/6/2011
Vivek M. Rege
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This condition is frequently seen in both girls & boys. This is noticed soon after birth when the umbilical cord falls off. There is a bulge in the region of the umbilicus with skin cover. The swelling increases when the child cries or strains, and may or may not be seen when the child is sleeping or lying quietly.

During the formation (embryology) , the fetus is formed by 4 folds which come together to meet at the future umbilicus. If, there is any delay or pause in the closure, there remains a gap through which the contents of the abdomen can come out. Thus when the child cries or increases the abdominal pressure ? the intestines come out thru this gap or hole in the region of the umbilicus, and may go back inside when the pressure comes to normal.

Figure: Umbilical Hernia


Left to itself in the natural course of events, this gap may automatically narrow with passage of time and may ultimately close totally. In such cases there is no need for any surgical intervention. However there is no way to predict which ones will close and when. During the period when we are waiting for the natural process, there may be complications " like the intestines coming out thru the gap beneath the skin and then not being able to go back " irreducibility. This will give pain at first, then the obstruction to the contents within the intestines from progressing forward, leading to vomiting. If this continues for a longer period of time, then the intestines proximal to those that are obstructed start getting dilated . Still further the blood supply to the intestines which are stuck may gradually get squeezed between the edges of the gap in the muscle and this will lead to gangrene of the intestines and gross infection, at times perforation of the intestines. If the complication can be tided over by early diagnosis and manual reduction by a doctor then there is no harm done. If the obstructed hernia is not reducible then an emergency surgery needs to be done to reduce the hernia and then to repair the defect. Even after the complication is tided over by manual reduction, there is now no reason to wait any further and as soon as possible, the hernial defect must be closed at the earliest.



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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