Most umbilical hernias will close by 4 to 5 years of age without treatment.
Complications including incarceration, strangulation, and rupture are uncommon in children.
Elective outpatient repair is associated with a low recurrence rate.
Infection and bleeding are the two most common postoperative complications.
Compression therapy (such as abdominal binders) is not helpful and may be harmful.
An umbilical hernia is a defect of the anterior abdominal wall fascia that occurs when the umbilical ring fails to close. The defect allows protrusion of a peritoneal sac that is covered by skin and may contain intra-abdominal contents, such as omentum or bowel.
History and exam
Key diagnostic factors
- presence of risk factors
- present since birth
- bulge at the umbilicus
- change in size/tension during movement
- skin changes
- easily reducible hernial sac
- well-defined rim of fascia with central defect
- variable diameter of defect
- symptoms of small bowel obstruction
Other diagnostic factors
- intermittent discomfort
- low birth weight
- African/African-American ancestry
- Beckwith-Wiedemann syndrome (BWS)
- trisomy 21, 18, 13
- congenital hypothyroidism
1st investigations to order
- diagnosis is clinical
large or symptomatic hernia
small and asymptomatic hernia
Charles L. Snyder, MD
Professor of Surgery
Chief, Section of Surgery
University of Missouri-Kansas City
Children's Mercy Hospital
CLS declares that he has no competing interests.
Charles M. Leys, MD, MSCI
Associate Professor of Surgery
University of Wisconsin School of Medicine and Public Health
American Family Children's Hospital
CML declares that he has no competing interests.
Michael A. Skinner, MD
Professor and Vice Chairman
University of Texas Southwestern Medical Center
MAS declares that he has no competing interests.
Bangalore S. Ramanand, MS, DNB, FRCS, MSC
Locum Consultant Surgeon
Glan Clwyd Hospital
BSR declares that he has no competing interests.
LS Wong, MB ChB
Professor of Surgery
University Hospitals Coventry
LSW declares that he has no competing interests.
Emmanuel Atta Agaba, MD, FRCS, FACS
Fellow in Minimally Invasive Surgery
Montefiore Medical Center at Albert Einstein College of Medicine
Bronx, New York City
EAA declares that he has no competing interests.
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