UMBILICAL HERNIAS
Category: Pediatric Surgery
Abstract : Umbilical Hernias : Between the sixth and tenth gestational week, the developing gastrointestinal tract is partially extruded into the umbilical cord with return into the abdomen by the tenth week. By the time of birth, the umbilical ring has become entirely closed by the developing abdominal wall except for the space occupied by the cord, which contains the umbilical vein, paired umbilical arteri
Umbilical Hernias : Between the sixth and tenth gestational week, the developing gastrointestinal tract is partially extruded into the umbilical cord with return into the abdomen by the tenth week.
By the time of birth, the umbilical ring has become entirely closed by the developing abdominal wall except for the space occupied by the cord, which contains the umbilical vein, paired umbilical arteries, and the fibrous remnants of the urachus and omphalomesenteric duct (yolk sac). After ligation of the cord, the vessels thrombosed and the cord dries and sloughs off, leaving a granulating surface that heals by cicatrization and is covered by epithelium. This is followed by scar contraction and retraction of the umbilicus. It is believed that most umbilical hernias occur through the cephalad portion of the umbilical ring, where the contracted scar around the obliterated umbilical vein is less dense than in the caudal portion of the scar. Umbilical hernias are very common, especially in prematures, blacks, and certain syndromes, such as Down's. The incidence decrease with age since many will close spontaneously. The diagnosis is made by physical exam, there is a fascial defect at the umbilicus. Complications such as strangulation or incarceration are extremely rare in children. Umbilical strapping should not be done since it does not promotes closure and may lead to skin erosion. Elective repair is usually delayed until after five years of age since closure may occur spontaneously or the defect may get smaller, allowing easier repair. Operative repair includes excision of the sac and horizontal one-layer closure through a small infraumbilical incision.
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