umbilical hernia

Etiology

• congenital
  • failure of the umbilical scar to heal at birth
• acquired: increased abdominal pressure due to
  • obesity
  • abdominal distension
  • ascites
  • pregnancy

Epidemiology

• congenital
  • 10-30% of population
  • more common in African Americans than Caucasions
• acquired: female:male ratio 3:1

Pathology

• opening in linea alba
• generally incarcerated in men, reducible in women close to their ideal body weight
• generally omentum &/or peritoneal fat herniates through abdominal wall

Clinical manifestations

• soft protruberance at the umbilicus
• may or may not be tender
• omental strangulation associated with persistent pain

Complications

• incarcetation & strangulation of bowel (Richter's hernia)

Management

• observation if small & asymptomatic
• surgical repair, open vs laparoscopic
  • generally done under local anesthetic
  • mesh placed deep to fascia
  • delay surgery until 4-5 years of age in children
• if ascites present
  • may be left alone if no skin breakdown
  • risk of fluid loss & electrolyte imbalances

More general terms

• abdominal wall hernia (ventral hernia)

More specific terms

• omphalocele
• Richter's hernia