Umbilical Hernia In Infants
Definition
An umbilical hernia is the protrusion of abdominal contents through the abdominal wall at the umbilicus, the defect in the abdominal wall and protruding intestine being covered with skin and subcutaneous tissue. An infant with an abdominal hernia has a soft bulge of tissue around the navel that may protrude when the baby cries, coughs or strains.
Description
During the growth of the fetus, the intestines grow more rapidly than the abdominal cavity. For a period, a portion of the intestines of the unborn child usually lies outside the abdomen in a sac within the umbilical cord. Normally, the intestines return to the abdomen, and the defect is closed by the time of birth. Occasionally, the abdominal wall does not close solidly, and umbilical hernia results. This defect is more likely to be seen in premature infants and in girls than boys. The defect in the abdominal wall usually closes by itself. Coughing, crying, and straining temporarily cause the sac to enlarge, but the hernia never bursts and digestion is not affected. When the baby cries, a small part of the intestine is pushed through the umbilical ring and makes the navel puff out somewhat. This is the umbilical hernia. When the ring is small, the protrusion of the hernia is never much larger than a pea and the ring is likely to close over in a few weeks or months. When the ring is large, it may take months or even years to close and the protrusion may be larger than a cherry. It used to be thought that the closing of the umbilical ring could be hastened by putting a tight strap of adhesive across the navel to keep it from protruding. It is now believed that strapping makes no difference. It is much easier not to bother with the adhesive, which always became soiled, soon loosened, and left raw places on the skin.
Treatment
There is little need to worry about the protrusion of the hernia. It rarely causes any trouble, as other hernias do. There is no need to keep the baby from crying. In the well-padded, older child or adult, the fat over the abdomen is thick enough to make the navel appear to be at the bottom of a hole. This is rarely the case in the first 2 or 3 years of life. The folds of the skin of the navel (looking something like a rosebud) stand right out on the full abdomen. This prominence of the skin folds on the navel should not be confused with a hernia. A hernia can be felt underneath the skin folds, like a small, soft balloon. A hernia makes the navel stick out farther than it would otherwise. If an umbilical hernia is still large after a few years and showing no decrease, surgical repair is sometimes recommended. Umbilical hernia should be distinguished from omphalocele, in which the intestines protrude directly into the umbilical cord and are covered only by a thin membrane. Omphalocele is a surgical emergency that must be treated immediately after birth.
Questions
What treatment do you recommend? Will surgery be required now or in the future? What is the procedure of the surgery? Are there any complications to this surgery? How long will the infant stay in the hospital? What measures need to be taken after surgery to protect the area? What are the possibilities the hernia will protrude again? Are there any measures to prevent the reoccurrence?
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