Umbilical hernia - Symptoms, diagnosis and treatment | BMJ Best Practice

Last reviewed:September 2019

Last updated:December 2017

Summary

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 2 most common postoperative complications.

Compression therapy (such as abdominal binders) is not helpful and may be harmful.

Definition

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. com.bmj.content.model.Caption@8d518f7 [Figure caption and citation for the preceding image starts]: Large umbilical herniaPersonal collection of Charles L. Snyder, MD; used with permission [Citation ends].

History and exam

Key diagnostic factors

present since birth
bulge at the umbilicus
change in size/tension during movement
skin changes
easily reducible hernia sac
well-defined rim of fascia with central defect
variable diameter of defect
symptoms of small bowel obstruction

Other diagnostic factors

intermittent discomfort

Risk factors

low birth weight (<1500g)
African/African-American ancestry
Beckwith-Wiedemann syndrome (BWS)
trisomy 21, 18, 13
congenital hypothyroidism
mucopolysaccharidoses

Diagnostic investigations

1st investigations to order

diagnosis is clinical

Treatment algorithm

ACUTE

incarcerated hernia

ONGOING

large or symptomatic hernia

small and asymptomatic hernia

Contributors

AuthorsVIEW ALL 

Charles L. Snyder, MD

Professor of Surgery

Chief, Section of Surgery

University of Missouri-Kansas City

Children's Mercy Hospital

Kansas City

MO

Disclosures

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

Madison

WI

Disclosures

CML declares that he has no competing interests.

Peer reviewersVIEW ALL 

Michael A. Skinner, MD

Professor and Vice Chairman

Pediatric Surgery

University of Texas Southwestern Medical Center

Dallas

TX

Disclosures

MAS declares that he has no competing interests.

Bangalore S. Ramanand, MS, DNB, FRCS, MSC

Locum Consultant Surgeon

Glan Clwyd Hospital

Rhyl

UK

Disclosures

BSR declares that he has no competing interests.

LS Wong, MB ChB

Consultant Surgeon

Honorary Associate

Professor of Surgery

University Hospitals Coventry

UK

Disclosures

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

NY

Disclosures

EAA declares that he has no competing interests.

Use of this content is subject to our disclaimer