Umblical Hernia- Symptoms, Risk factors, and more

Dr. Saikrupa, MBBS

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In general, a Hernia is defined as an abdominal protrusion occurring due to weakness of abdominal wall muscles.

The umblical cord is shed after a few weeks of birth, and the defect is called umblicus. Usually, they close in a few weeks after shedding, but if the abdominal muscle doesn’t layer up properly, they tend to be weak, resulting in a protrusion of the abdominal contents through the defect ending in an Umblical Hernia.

Types across age groups

1. Newborn – Exomphalos major and minor – Seen more in males than females
2. Infants and children
3. Adults – Seen more in females than males

Examphalos  

• It is also known as Omphalocele, in newborns, the midgut fails to seal during the developmental stage, which causes abdominal muscle weakness.
• Minor – The attachment of the umblicus cord on top of the protruding sac.
• Avoidance of prone position of child before surgery should be followed as it may cause damage to the intestines.
• Major – Attachment of umblicus cord to the inferior of the sac.

• Risks   
• Rupture of sac chances are high.Still born rate is high. Absence of abdominal musculature is common.
• Infants and children – Umblical Hernia
• Mostly a complication occurring as a result of umblical sepsis.
• Symptoms – Incessant cry, and the child will have a swelling at the place of the umblicus.
• Treatment
• Reassurance
• Strapping of the sac
• Surgical repair is needed only if the Hernia is not automatically corrected by itself before the age of 2.
• Umblical Hernia – adults  

Risk factors  

• Mostly females in their age of 50’s.
• Morbidly obese adults.
• Repetitive pregnancies or multigravida pregnancies.  
• Patients who underwent peritoneal dialysis multiple times.
• Ascites in cirrhotic patients.

Symptoms  

• Symptoms are different from that of a child. Adults have swelling above or below, or near the umblicus scar, which increases in size during straining or coughing – Exapansile cough impulse.
• Inguinal Hernia may be an add-on condition, which increases the complication of strangulation.
• Can be reduced, but a pulsing sensation or gurgling effect may be present if there is a blood vessel or the small intestine present in the sac respectively.
• Pain will be severe, which is called as dragging pain.

Complications  

• Irreducibility of sac due to presence of adhesions.
• Colicky pain may occur if there is any obstruction which leads to the patient having increased vomiting and distension. So, if left untreated, it may end up in strangulation. And that strangulation may cause discolouration of the skin.
• More importantly, if the transverse colon is involved, it is called ‘an incarcerated Hernia’, which requires urgent intervention.
• In both scenarios failing to intervene at the right moment will make the Hernia end up in gangrene and complicate it further, thus increasing the mortality – a very rare scenario.
• Intertrigo – Discoloration of surrounding skin occurring due to friction of the sac, which sags due to its weight and gravity.

Treatment  

• First and foremost, the patient should start reducing their weight after the reduction of Hernia.
• If surgical repair is suggested, then mostly the tensionless laparoscopic mesh repair is preferred.
• Mayo’s umblical herniorraphy is another preferred surgery for Umblical Hernia where the umblicus is excised, contents are reduced and umblicoplasty is done later.

Conclusion

As a parent, one should be aware of the minuscule changes in the child’s body and behaviour. Make sure to go to an emergency room if you notice the child having any reddish swelling with incessant crying, vomiting and is in pain. As an adult, one should not postpone going to the doctor if one seems to experience any pain in the abdomen with a protruding swelling, and only a prompt approach will help in reducing the complications.

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