Umbilical hernia


Congenital umbilical hernia is a congenital malformation of the umbilicus.

Three times more common in women than in men, but among children, the ratio is roughly equal.

More common in children of African descent.

Acquired umbilical hernia  results from increased intra-abdominal pressure caused by obesity, heavy lifting, a long history of coughing, or multiple pregnancies.

Umbilical hernia in the newborn tend to resolve without any treatment by around the age of 2–3 years.

An 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.

The size of the base of the herniated tissue is inversely correlated with risk of strangulation.

Umbilical hernias common in newborns because during fetal development abdominal organs form outside the abdominal cavity, later returning into it through an opening which will become the umbilicus.

Umbilical hernia must be distinguished from a paraumbilical hernia, which occurs in adults and involves a defect in the midline near to the umbilicus, and is from an omphalocele.

When the orifice is < 1 or 2 cm, 90% close within 3 years.

If hernias are asymptomatic, reducible, and don’t enlarge, no surgery is needed.

An umbilical hernia can be fixed by stitching the walls of the abdomen or placing mesh over the opening and stitching it to the abdominal walls.

The latter is of a stronger hold and is commonly used for larger defects in the abdominal wall.

Most umbilical hernias in infants and children close spontaneously and rarely have complications of gastrointestinal incarcerations, and are not repaired until 5-6 years of age.

Abdominal muscles converge and fuse at the umbilicus during the formation stage, but in some cases a gap remains where the muscles do not close and through this gap the intestines bulge giving rise to an umbilical hernia.

Postoperative mortality of herniorrhaphy in noncirrhotic individuals is 1% and 5.5% in cirrhotic patients in a Danish study of nearly 23,000 patients.

In an American study the morbidity in 32,000 patients with elective hernia repair was 15.6% in cirrhotic patients and 13.5% for non cirrhotic patients, while in emergent hernia repair morbidity for cirrhotic patients compared to non cirrhotic patients approached clinical significance (17.3% versus 14.5%).

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