Umbilical Hernia

Vibhor Borkar, Dr Kirti Naranje
Pathophysiology And Clinical Presentation
Almost 10-20% of the children have umbilical hernia. Boys and girls are equally affected. It is found more often (20-30%) in African-American children and 4% in white children. Incidence is more in infants with prematurity, low birth weight, congenital hypothyroidism, Down syndrome, trisomy 13, trisomy 18, trisomy 21, Hurler’s syndrome, Beckwith-Wiedemann syndrome or children requiring peritoneal dialysis.1

Patho-physiology for umbilical hernia:
Umbilical region is involved in very complex activities in the intra-uterine life. In embryonal stage, a wide-open communication exists between the yolk sac and primitive gut. During the fetal development in the womb, the mid-gut from the baby is herniated outside the body in the yolk sac at 32 day, the rotation of the gut takes place. This physiological umbilical hernia remains till 9th weeks and in 10th week the intestines returns back to the abdominal cavity. In 3rd trimester, the aperture around the umbilical vessels and urachus narrows. In post-natal stage, the umbilical ring is formed when mesoderm of muscle and fascia around the umbilical vessels and urachus contracts. Umbilical hernia is caused by failure of closure of the umbilical ring.2

Clinical Anatomy of umbilical hernia:
Umbilical ring (fibro-muscular ring) is a wide defect in the abdominal wall. The actual fascial defect varies in size, ranging from 1 to 4 cm. The ring is anteriorly bordered by linea alba, laterally by rectus sheath and posteriorly by umbilical fascia and peritoneum (Figure 1). When the abdominal content (bowel and/ or mesenteric fat) herniates through the ring, they are covered with peritoneum. (Figure 2). The extent of the skin protrusion is not indicative of size of umbilical defect. So it is important to reduce the content of the hernia and palpate for the actual size of the ring.1, 2

Figure 1: Schematic diagram of abdominal wall layers in health.
Schematic diagram of abdominal wall layers in health.

Figure 2: Schematic diagram of umbilical hernia and its relation to abdominal wall layers
Schematic diagram of umbilical hernia and its relation to abdominal wall layers

Signs and symptoms:
Children with umbilical hernia presents early in the life as bulge in the umbilicus. The bulge becomes more prominent after crying or coughing or straining. Otherwise they are asymptomatic and it rarely causes pain. The sac may content a loop of bowel that is easily pushed back into the abdomen or some peritoneal fat.1, 2

Umbilical Hernia Umbilical Hernia 05/11/2016
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