Umbilical Hernias

Question 1

Incidence

Answer 1

Incidence 2-14% Increases with prematurity Decreases with increasing age

Question 2

Pathophysiology

Answer 2

😓Incomplete closure of peritoneal and fascial layers within umbilicus
🤗by 4 yr Hernia is peritoneumlined and skin-covered Size of fascial defect determines chances of spontaneous closure

Question 3

Clinical picture

Answer 3

Majority asymptomatic Majority (95%) spontaneously resolve by age 4 Incarceration prior to age 5 very rare Most symptoms occur in late adolescence or adulthood

Protrusion from umbilicus Different from less common abdominal wall hernias that do not spontaneously resolve (e.g. epigastric hernias) Most defects >1.5 cm in infancy will not close spontaneously

Question 4

TX

Answer 4

Repair if not spontaneously closed by age 5 Earlier repair of large “proboscoid” hernias with extensive skin stretching may be warranted for cosmetic reasons Simple primary closure of fascial defect