Umbilicus – Herniation
Umbilicus – Herniation: Excerpt from In A Page: Pediatric Signs and Symptoms
Umbilical hernias are a common pediatric condition, with an estimated incidence of 1/6 children. Umbilical hernias are 10 times more common in black as compared to white children. Umbilical hernias are also seen more frequently in low birth weight infants. The majority of umbilical hernias spontaneously resolve by 5 years of age.
Differential Diagnosis
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Normal variant
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Diastasis recti abdominis
–Very common
–Supraumbilical rectus muscles separated
laterally
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Athyrotic hypothyroidism sequence
–Primary defect in thyroid gland development
–58% have associated umbilical hernias
- Omphalocele
–Herniation of abdominal contents into umbilical cord, covered only by peritoneum not by skin
–Often associated with genetic syndromes
- Gastroschisis
–Intact umbilical cord
–Evisceration of bowel through a defect in the
abdominal wall, usually found on the right side of the cord without an overlying membrane
- Genetic syndromes
–Beckwith-Wiedemann syndrome
–Exomph alos-macroglossia-gigantism
–May be associated with umbilical hernia or omphalocele
–Pentalogy of Cantrell: Omphalocele, pericardial defect, sternal defect, cardiac defect (commonly tetralogy of Fallot), diaphragmatic hernia
Workup and Diagnosis
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History and physical exam
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Umbilical hernia is covered by skin
–Presents as a swelling or bulge that increases with any
Valsalva maneuver
–Easily reduced
–Fascial defect 1–5 cm in diameter
–May contain omentum or small intestine
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Most usually appear by 6 months of age and resolve by 1 year of age spontaneously
–Almost all disappear by 5–6 years of age
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If child is not black, assess for possible associated syndromes
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Labs may include T4 or thyroid stimulating hormone levels, karyotype
Treatment
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Observation is often all that is needed
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Covering the hernia or “strapping” is not useful
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Surgery is indicated only if:
–The defect enlarges after 1–2 years of age
–Symptomatic
–Incarceration or strangulation
–Persistent at 3–5 years of age
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Umbilical hernias are less likely to close if defect >1.5 cm or if it is a large proboscoid umbilical hernia with excessive overlying skin
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Incarceration of an umbilical hernia is rare, occurring in
only 1/1,500 hernias
–Occurs more frequently if fascial defect >1.5 cm
–Usually only contains omentum and not intestine
Book Source Details
- Book Title: In A Page: Pediatric Signs and Symptoms
- Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
- Year of Publication: 2007
- Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: In A Page: Pediatric Signs and Symptoms
Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 1-4051-0427-9
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