Umbilical hernia

Key points

An umbilical hernia is a protrusion of the abdominal lining - or part of an abdominal organ - through the navel. This is a particularly common condition in infants and young children, especially of African ethnicity; adults and the elderly can also be affected.

Classification
There are several variants of umbilical hernia:

• EMBRYO HERNIA: often incompatible with the life of the unborn child
• FETAL HERNIA: appears after the third month of gestational life
• CHILD OR NEWBORN HERNIA: the most common of all. It tends to resolve spontaneously in a few months
• ADULT UMBILICAL HERNIA: requires specific surgery

Causes

• In children, the umbilical hernia is almost always congenital and depends on a defect in the abdominal wall closing after the umbilical cord falls. Rarely, the herniation depends on serious secondary diseases (eg collagen diseases).
• In the adult, umbilical hernia depends on the increase in intra-abdominal pressure, in turn caused by cirrhosis, ascites, multiple pregnancies, tumors, obesity.

Symptoms
Umbilical hernia causes pain, swelling and limited burning. The pain is accentuated with a cough or sneeze. Complications → in adults, an untreated umbilical hernia can degenerate into an incarcerated hernia or strangulated hernia.

Therapies

Infantile umbilical hernias spontaneously regress within 12-18 months of life. In adults, umbilical hernia requires surgery

What is the umbilical hernia?

An "umbilical" is defined as an "abdominal hernia that develops in correspondence with the umbilical scar.

In other words, an umbilical hernia is a protrusion - hence an outward bulge - of the abdominal lining or part of an organ through the navel.
Umbilical hernia is a generally harmless clinical condition, and is quite common in children; however, what has been said does not exclude the possibility that adults and the elderly are affected. In adults, it is estimated that umbilical hernia represents the 6% of all abdominal hernias: the disorder occurs in particular in women between the ages of 35 and 60. The umbilical hernia is extremely common in individuals of African ethnicity.
In newborns and older children, the umbilical hernia tends to resolve spontaneously within a few months; otherwise, in adults this form of abdominal hernia almost always requires specific surgery.

Age classification

There are several types of umbilical hernia, distinguished according to the "age of onset":

1. EMBRYO HERNIA: it is the result of an arrest in the development of the abdominal wall during the embryonic period. The embryonic umbilical hernia is an extremely dangerous form, so much so that it often proves incompatible with the life of the unborn child due to the associated malformations. It is almost unthinkable to surgically reconstruct the abdominal wall of the embryo.
2. FETAL HERNIA: to be defined "fetal" the umbilical hernia must appear after the third month of intrauterine life, that is when the peritoneal cavity is already regularly developed. The umbilical ring is already formed, although it has remained very large. In this case, the fetus can be operated on surgically.
3. CHILD OR NEWBORN HERNIA: it is the most common form of umbilical hernia ever, which occurs in the period between the fall of the umbilical stump and the 6th month of life (in most cases). The neonatal hernia is due to a defect in the closure of the abdominal wall after the fall of the umbilical cord. In general, no surgery is necessary: ​​the hernia tends to regress spontaneously, resolving itself within 6-12 months.
4. UMBILICAL HERNIA IN THE ADULT: typical hernia due to "weakness", in the adult it is generally due to the loss of tone of the abdominal muscles. In the vast majority of cases, this form of herniation requires surgery.

To fix the concepts ...

Umbilical hernia in children and adults

Unlike that of the adult, the umbilical hernia of the child tends to resolve spontaneously without the need for medical intervention. The above is explained by the underlying cause: in the child, the umbilical hernia generally has a " congenital and it manifests itself in the first months of life, while in the adult the problem is due to a weakness acquired of the abdominal wall.

Classification based on size

A "further classification of umbilical hernias is performed according to the size of the hernial collar:

• Small umbilical hernia: the diameter is less than 2 cm
• Umbilical hernia of medium size: the diameter measures 2-4 cm
• Large umbilical hernia: the diameter exceeds 4 cm

Causes

In the small BABY, the umbilical hernia is caused by a defect in the abdominal wall closing after the umbilical cord falls. Let us briefly recall that during gestation the umbilical cord passes through a small opening located in the abdominal muscles of the fetus. This orifice closes. only after birth: later, if the muscles do not unite perfectly in the midline of the abdomen, it is possible that the child will manifest a hernia, soon reversible.
Only rarely does the umbilical hernia in the child present large dimensions: in such situations, it is possible to suspect that the disorder is related to serious secondary diseases, such as:

• Disorders of collagen and polysaccharide metabolism:
  • Hunter-Hurler syndrome, characterized by disharmonic dwarfism, alteration of the skin and cornea, mental retardation;
  • osteogenesis imperfecta: genetic anomaly in which the affected patient, due to a serious anomaly in collagen synthesis, presents serious changes in the joints, spine, ears, skin and teeth;
  • Ehlers-Danlos syndrome: the patient with this genetic disease has hyperplasticity of the skin and laxity of the ligaments. The disease affects the connective tissue due to a collagen mutation;
• Congenital hypothyroidism;
• Down syndrome;
• Freeman-Sheldon syndrome (or blowing face syndrome): this is a rare congenital disorder characterized by abnormalities of the spine and face;
• Fetal hydantoin syndrome (hydantoin is a drug used to treat epilepsy).

In the ADULT, on the other hand, umbilical hernia is a less frequent phenomenon, although more problematic, since it requires specific surgery. In similar circumstances, the umbilical hernia is the result of the increase in intra-abdominal pressure, in turn caused by:

• Ascites (accumulation of fluid in the abdominal cavity)
• Cirrhosis
• Pregnancies (especially multiple)
• Obesity / overweight
• Extreme effort (heavy lifting)
• Previous history of abdominal surgery
• Tumor in the abdominal cavity
• Flabby belly

Genetic predisposition also plays a leading role in the manifestation of umbilical hernia in adults.

Umbilical Hernia - Symptoms and Therapy "