Umbilical/paraumbilical hernia Flashcards
1
Q
Define a ‘True umbilical hernia’
Relate it to the embryological origin of the umbilicus
A
- A true umbilical hernia is a defect in the anterior abdominal wall underlying the umbilicus, through which the intestine can protrude
- Occurs in 3% of live births as a result of a defect in the transversalis fascia at the umbilical ring
- It results from failure to completely close the umbilical cicatrix
- It allows for herniation during periods of increased intra-abdominal pressure.
2
Q
Define paraumbilical hernia. Cause?
A
An acquired hernia that occurs just above/below the umbilicus. They are caused by raised intra-abdominal pressure.
3
Q
What are risk factors for paraumbilical hernias?
A
They are caused by raised intra-abdominal pressure so are more common in obese, middle aged, multiparous (more than one child at birth e.g. twins) women.
4
Q
What is an exomphalos hernia?
A
- Rare, failure of the gut (mid-gut) to return to the abdominal cavity following the embryological rotation that occurs outside of the body.
- The bowel is contained within a translucent sac which runs through the defective anterior abdominal wall
- Requires urgent surgery
5
Q
What are the symptoms for a patient with true umbilical hernia?
Reducible?
Become obstructed?
A
- Usually asymptomatic, more prominent on coughing/laughing but easily reducible.
- Very rarely become obstructed.
- 90% retract by the age of 2
6
Q
What are the symptoms for a patient with paraumbilical hernia?
Reducible?
Become obstructed?
A
- They present with a localised dragging pain and enlarging hernia over time, often tender with colic from intermittent obstruction of the bowel.
- Mainly reducible, but due to the small neck they commonly strangulate/obstruct.
- Adhesions may develop.
7
Q
What are they signs that a hernia may be strangulated?
A
Findings supporting strangulation include:
- redness
- warmth
- swelling
- pain.
