Umbilical and midline abdominal hernias

Umbilical hernia is common in the newborn period and results from a delay in the closure of the umbilical ring. The intestinal contents are easily reducible and complications are extremely rare. The majority will resolve spontaneously. Surgery (repair of fascial defect with a periumbilical incision) is indicated only in the minority of cases which persist after the age of 4 years. Hernias with a diameter greater than 1.5 cm are unlikely to close spontaneously. Umbilical hernia related to increased intra-abdominal pressure, for example ascites, is a separate clinical entity and management is directed at the underlying cause.

Hernias in the midline of the abdominal wall excluding the umbilicus represent abnormal defects in the fascia and are most commonly located near the umbilicus: paraumbilical hernia, supraumbilical hernia. They may also be located anywhere along the midline between the xiphisternum and the umbilicus: epigastric hernia. Usually, an extraperitoneal pad of fat (or occasionally the omentum) protrudes through a small defect, presenting as a pea-sized swelling which is best felt by rolling the fingers along the midline of the abdominal wall. There may be a history of abdominal pain. Surgical repair is indicated. It is essential that the site of hernia is marked preoperatively as the hernia may be difficult to locate when the child is anaesthetized and in a reclined position.

Divarication of recti occurs commonly in infants and requires no treatment.

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