Umbilical hernia

An umbilical hernia is a health condition

where the abdominal wall behind the navel
is damaged. It may cause the navel to
bulge outwards—the bulge consisting of
abdominal fat from the greater omentum
or occasionally parts of the small
intestine. The bulge can often be pressed
back through the hole in the abdominal
wall, and may "pop out" when coughing or
otherwise acting to increase intra-
abdominal pressure. Treatment is surgical,
and surgery may be performed for
cosmetic as well as health-related
reasons.

Umbilical hernia

Children with umbilical hernias, Sierra Leone

(West Africa), 1967.

Specialty General surgery

Signs and symptoms
A hernia is present at the site of the
umbilicus (commonly called a navel or
belly button) in newborns; although
sometimes quite large, these hernias tend
to resolve without any treatment by around
the age of 2–3 years.[1] 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 (i.e., a narrow
base is more likely to strangulate).
Babies are prone to this malformation
because of the process during fetal
development by which the abdominal
organs form outside the abdominal cavity,
later returning into it through an opening
which will become the umbilicus.[2]

Hernias may be asymptomatic and

present only as a bulge of the umbilicus.
Symptoms may develop when the
contracting abdominal wall causes
pressure on the hernia contents. This
results in abdominal pain or discomfort.
These symptoms may be worsened by the
patient lifting or straining.
Causes

In more severe cases of umbilical hernias, the small

intestine can poke out through the opening. This can
very rarely cause ischemia and necrosis of the
intestine and is potentially life-threatening. The
bulge is often caused by fat or parts of the greater
omentum.

The causes of umbilical hernia are

congenital and acquired malformation, but
an apparent third cause is really a cause of
a different type, a paraumbilical hernia.
Congenital E…

Congenital umbilical hernia is a congenital

malformation of the navel (umbilicus).
Among adults, it is three times more
common in women than in men; among
children, the ratio is roughly equal.[3] It is
also found to be more common in children
of African descent.[4][5][6]

Acquired E…

An acquired umbilical hernia directly

results from increased intra-abdominal
pressure caused by obesity, heavy lifting, a
long history of coughing, or multiple
pregnancies.[7][8] Another type of acquired
umbilical hernias are incisional hernias,
which are hernia developing in a scar
following abdominal surgery, e.g. after
insertion of laparoscopy trocars through
the umbilicus.

Paraumbilical E…

Importantly, an 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 from omphalocele.

Diagnosis
Navels with the umbilical tip protruding
past the umbilical skin ("outies") are often
mistaken for umbilical hernias, which are a
completely different shape. Treatment for
cosmetic purposes is not necessary,
unless there are health concerns such as
pain, discomfort or incarceration of the
hernia content. Incarceration refers to the
inability to reduce the hernia back into the
abdominal cavity. Prolonged incarceration
can lead to tissue ischemia (strangulation)
and shock when untreated.

Umbilical hernias are common. With a

study involving Africans, 92% of children
had protrusions, 49% of adults, and 90% of
pregnant women. However, a much
smaller number actually suffered from
hernias: only 23% of children, 8% of adults,
and 15% of pregnant women.[4]

When the orifice is small (< 1 or 2 cm),

90% close within 3 years (some sources
state 85% of all umbilical hernias,
regardless of size), and if these hernias
are asymptomatic, reducible, and don't
enlarge, no surgery is needed (and in other
cases it must be considered).
 Play media

Ultrasound showing an incarcerated

umbilical hernia[9]

Play media

Ultrasound showing an incarcerated

umbilical hernia[9]
 Ultrasound showing an incarcerated
umbilical hernia[9]

Treatment

Children E…

In some communities mothers routinely

push the small bulge back in and tape a
coin over the palpable hernia hole until
closure occurs. This practice is not
medically recommended as there is a
small risk of trapping a loop of bowel
under part of the coin resulting in a small
area of ischemic bowel. This "fix" does not
help and germs may accumulate under the
tape, causing infection. The use of
bandages or other articles to continuously
reduce the hernia is not evidence-based.

An umbilical hernia can be fixed in two

different ways. The surgeon can opt to
stitch the walls of the abdomen or he/she
can place mesh over the opening and
stitch it to the abdominal walls. The latter
is of a stronger hold and is commonly
used for larger defects in the abdominal
wall. Most surgeons will not repair the
hernia until 5–6 years after the baby is
born. Most umbilical hernias in infants and
children close spontaneously and rarely
have complications of gastrointestinal-
content incarcerations.[10]

How far the projection of the swelling

extends from the surface of the abdomen
(the belly) varies from child to child. In
some, it may be just a small protrusion; in
others it may be a large rounded swelling
that bulges out when the baby cries. It may
hardly be visible when the child is quiet
and or sleeping.
Normally, the abdominal muscles
converge and fuse at the umbilicus during
the formation stage, however, in some
cases, there remains a gap where the
muscles do not close and through this gap
the inner intestines come up and bulge
under the skin, giving rise to an umbilical
hernia. The bulge and its contents can
easily be pushed back and reduced into
the abdominal cavity.

Recently, a novel technique of treatment of

umbilical hernia in infants was published
by Dr. Ganesh Kumar K Ammannaya.
Named as Ammannaya’s Technique [11],
after the innovating surgeon, this new
technique facilitates speedy resolution of
hernia without the need for surgery in a
matter of 6-8 weeks at the cost of 2 USD
and without any adverse effects.

In contrast to an inguinal hernia, the

complication incidence is very low, and in
addition, the gap in the muscles usually
closes with time and the hernia disappears
on its own. The treatment of this condition
is essentially conservative: observation
allowing the child to grow up and see if it
disappears. Operation and closure of the
defect is required only if the hernia
persists after the age of 3 years or if the
child has an episode of complication
during the period of observation like
irreducibility, intestinal obstruction,
abdominal distension with vomiting, or red
shiny painful skin over the swelling.
Surgery is always done under anesthesia.
The defect in the muscles is defined and
the edges of the muscles are brought
together with sutures to close the defect.
In general, the child needs to stay in the
hospital for 1 day[12] and the healing is
complete within 8 days.

At times, there may be a fleshy red

swelling seen in the hollow of the
umbilicus that persists after the cord has
fallen off. It may bleed on touch, or may
stain the clothes that come in contact with
it. This needs to be shown to a pediatric
surgeon. This is most likely to be an
umbilical polyp and the therapy is to tie it
at the base with a stitch so that it falls off
and there is no bleeding. Alternatively, it
may be an umbilical granuloma that
responds well to local application of dry
salt or silver nitrate but may take a few
weeks to heal and dry.[13]

Adults E…

Many hernias never cause any problems,

and do not require any treatment at all.
However, because the risk of
complications with age are higher and the
hernia is unlikely to resolve without
treatment, surgery is usually
recommended.[2]

Usually hernia has content of bowel,

abdominal fat or omentum, tissue that
normally would reside inside the
abdominal cavity if it wasn't for the hernia.
In some cases, the content gets trapped in
the hernia sac, outside the abdominal wall.
The blood flow to this trapped tissue may
be compromised, or the content even
strangulated in some cases. Depending on
the severity and duration of blood flow
compromise, it can cause some pain and
discomfort. Usually the situation resolves
itself, when the protrusion of content is
returned to the abdominal cavity.
Sometimes this needs to be done by a
doctor at the ICU.[14]

If the hernia content get trapped combined

with severe pain, inability to perform bowel
movement or pass gas, swelling, fever,
nausea and/or discoloration over the area,
it could be signs of a prolonged
compromise in blood flow of the hernia
content. If so, emergency surgery is often
required, since prolonged compromise in
blood flow otherwise threatens organ
integrity.[14]
Hernias that are symptomatic and disturb
daily activity, or hernias that have had
episodes of threatening incarceration,
preventive surgical treatment can be
considered. The surgery is performed
under anaesthesia, while the surgeon
identifies the edges of the defect and bring
them together permanently using either
suture or mesh.[15] Small umbilical hernias
are often successfully repaired with suture,
while larger hernias may require a suitable
mesh,[16] although some surgeons
advocate mesh treatment for most
hernias. The most common complications
for both techniques are superficial wound
infections, recurrence of the hernia[17] and
some people experience pain from the
surgical site.[18]

See also
Fetal development
Umbilicoplasty
Paraumbilical hernia
Omphalocoele

References
1. Lissauer T, Clayden G (2007).
Illustrated Textbook of Paediatrics
(3rd ed.). Edinburgh: Mosby Elsevier.
ISBN 978-0-7234-3397-2.
2. "Umbilical hernia repair" . NHS
choices. UK.GOV. 2017-10-23.
Retrieved March 3, 2018.
3. Abdominal Hernias at eMedicine
4. Meier DE, OlaOlorun DA, Omodele RA,
Nkor SK, Tarpley JL (May 2001).
"Incidence of umbilical hernia in
African children: redefinition of
"normal" and reevaluation of
indications for repair". World Journal
of Surgery. 25 (5): 645–8.
doi:10.1007/s002680020072 .
PMID 11369993 .
5. Arca MJ (November 2016). "APSA -
Umbilical Conditions" (Website).
APSA - Family and Parent Resources.
Oakbrook Terrace, Illinois, USA:
American Pediatric Surgical
Association. Retrieved November 5,
2017.
6. MedlinePlus Encyclopedia Umbilical
hernia repair
7. Mayo Clinic staff. "Umbilical hernia:
Causes - MayoClinic.com" . Retrieved
2010-03-31.
8. "Hernia: MedlinePlus Medical
Encyclopedia" . 2014-10-25. Retrieved
2016-07-15.
 9. "UOTW #44 - Ultrasound of the
Week" . Ultrasound of the Week. 18
April 2015. Retrieved 27 May 2017.
10. Papagrigoriadis S, Browse DJ,
Howard ER (December 1998).
"Incarceration of umbilical hernias in
children: a rare but important
complication". Pediatric Surgery
International. 14 (3): 231–2.
doi:10.1007/s003830050497 .
PMID 9880759 .
11. Ammannaya GK, Sripad NS
(September 2019). "A Novel Cost-
Effective Technique for Speedy
Resolution of Infantile Umbilical
Hernia: Ammannaya's Technique".
Case Reports in Surgery.
doi:10.1155/2019/3806358 .
PMID 31583155 .
12. Barreto L, Khan AR, Khanbhai M, Brain
JL (July 2013). "Umbilical hernia".
BMJ. 347: f4252.
doi:10.1136/bmj.f4252 .
PMID 23873946 .
13. "Child with Umbilical
Swellings/Hernia" . Archived from the
original on April 7, 2013. Retrieved
2013-10-10.
14. Summers A (March 2014).
"Congenital and acquired umbilical
hernias: examination and treatment".
Emergency Nurse. 21 (10): 26–8.
doi:10.7748/en2014.03.21.10.26.e1
260 . PMID 24597817 .
15. Nguyen MT, Berger RL, Hicks SC,
Davila JA, Li LT, Kao LS, Liang MK
(May 2014). "Comparison of
outcomes of synthetic mesh vs
suture repair of elective primary
ventral herniorrhaphy: a systematic
review and meta-analysis". JAMA
Surgery. 149 (5): 415–21.
doi:10.1001/jamasurg.2013.5014 .
PMID 24554114 .
16. Dalenbäck J, Andersson C, Ribokas D,
Rimbäck G (August 2013). "Long-
term follow-up after elective adult
umbilical hernia repair: low
recurrence rates also after non-mesh
repairs". Hernia. 17 (4): 493–7.
doi:10.1007/s10029-012-0988-0 .
PMID 22971796 .
17. Winsnes A, Haapamäki MM,
Gunnarsson U, Strigård K (August
2016). "Surgical outcome of mesh
and suture repair in primary umbilical
hernia: postoperative complications
and recurrence". Hernia. 20 (4): 509–
16. doi:10.1007/s10029-016-1466-x .
PMID 26879081 .
18. Christoffersen MW, Helgstrand F,
Rosenberg J, Kehlet H, Strandfelt P,
Bisgaard T (April 2015). "Long-term
recurrence and chronic pain after
repair for small umbilical or
epigastric hernias: a regional cohort
study". American Journal of Surgery.
209 (4): 725–32.
doi:10.1016/j.amjsurg.2014.05.021 .
PMID 25172168 .

External links
Classification ICD-10: K42 • D

ICD-9-CM: 551 -553 •

MeSH: D006554 •

DiseasesDB: 23647

External resources MedlinePlus: 000987

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