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Umbilical Hernia

Occurring mostly in infants, a part of the fatty tissue projects through the umbilical opening near the navel. A small pouch is evident in the inner lining of the abdominal cavity when the contents push through it. Umbilical hernias are fairly common in premature babies. As the foetus develops, under normal conditions, the umbilical cord passes through the opening in the abdominal wall closes before the child is born. When the muscles do not seal completely, they leave a weak spot where an umbilical hernia can develop. Laughing, crying, heaving and coughing make a hernia more apparent. Umbilical hernias are painless and often do not cause any discomfort. In adults umbilical hernia is common in women after multiple child births. The abdominal wall becomes lax and the umbilicus becomes more prominent.

Signs and symptoms

In children: A bulge of approximately 1 to 5 cms in diameter near the navel; no symptoms are noticed when the baby is relaxed

In adults: Painful swelling or bulge near the navel

More serious symptoms in infants:

Prominent pain is noticed in the baby

Vomiting

Bulge is tender, discoloured and swollen

Causes and types

Congenital umbilical hernia: a congenital or birth malformation of the umbilicus; common in children as well as in adults

Acquired umbilical hernia: umbilical hernia as a result of heavy lifting, obesity, history of multiple pregnancies, chronic coughing

Paraumbilical hernia: Hernias involving the protrusion of the abdominal contents along with the mesenteric fat through a weakness near the navel

Diagnosis

Physical examination:

Detailed medical history and patient history is evaluated

Lump and pain at the umbilicus are present

Palpation of the fascial defect in women confirms the presence of a paraumbilical hernia

Abdominal ultrasound and CT scan only to diagnose complications

Treatment

Surgical intervention is advised in adults if the hernia causes pain and discomfort. If the hernia does not show any signs of reducing by itself, surgery is always recommended to avoid potential complications. Umbilical hernia repairs are carried out with mesh placements for patients with defects > 4 cm and recurrent hernias. Surgery is under general anaesthesia. It can be done either open or through key hole.

Dr. Deepak Varma looks for signs of reduction in infants by about 1 to 2 years of age, after which he offers a consultation for treatment of infantile umbilical hernias. For adults, he prescribes surgical intervention to avoid possible complications, especially in women.