Summary
Definition
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.[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
- African ancestry
- Beckwith-Wiedemann syndrome (BWS)
- trisomy 21, 18, 13
- congenital hypothyroidism
- mucopolysaccharidoses
Diagnostic tests
1st tests to order
- diagnosis is clinical
Treatment algorithm
incarcerated hernia
large or symptomatic hernia
small and asymptomatic hernia
Contributors
Authors
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.
Acknowledgements
Dr Charles L. Snyder wishes to gratefully acknowledge Dr Charles M. Leys, a previous contributor to this topic.
Disclosures
CML declares that he has no competing interests.
Peer reviewers
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.
References
Key articles
Vohr BR, Rosenfield AG, Oh W. Umbilical hernia in the low-birth-weight infant (less than 1,500 gm). J Pediatr. 1977 May;90(5):807-8. Abstract
Bowling K, Hart N, Cox P, et al. Management of paediatric hernia. BMJ. 2017 Oct 19;359:j4484. Abstract
Halpern LJ. Spontaneous healing of umbilical hernias. JAMA. 1962 Nov 24;182(8):851-2. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Epigastric hernia
- Hernia of the umbilical cord
- Omphalocele
More Differentials
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer