Hello, this is @verygoodsurgeon.
Have you ever been worried that your baby's bellybutton may have popped out more than others? Today, I'd like to talk about what umbilical hernia in infant and children is and how to treat it.
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The navel is the link between mom and fetus.
The navel is a mark of the umbilical cord that received nutrients and oxygen from the mother while the fetus was in her womb. As soon as the baby sees the lights of the world, the placenta is separated from the mother's body and the umbilical cord, including the blood vessels, is naturally closed.
As you can see in the picture, the dried umbilical cord is taken off naturally after around ten days. After that, the navel naturally remained.
What is Umbilical Hernia?
Umbilical hernia means that the intraperitoneal organs protrude and bulge out under the navel. It actually does pop out a lot, not just popped out a bit or looks ugly. You can suspect umbilical hernia, if the bellybutton pops out again right after you pressed it or if the small bowel rumbled under the navel. if the bellybutton pops out more than usual when the baby cries or strains, it is the most obvious.
Why is the umbilical hernia caused?
Basically, umbilical hernia is a disease that the abdominal wall beneath the navel is not closed by itself, or it is closed incompletely and the organs protrude. In medical terms, it is caused by 'the defect of umbilical ring'.
Approximately eighty percent of umbilical hernia naturally close, but it is difficult to close by itself if umbilical hernia defect is larger than 2cm. And if the abdominal wall is weak, he/she may have the symptoms when they become an adult and need to get a treatment, even though it is fine in their infancy.
How to treat?
Umbilical hernia has few complications, unlike inguinal hernia. The risk is low and about eighty percent of it close naturally as I said, so basically, it is better to watch it for two to five years without any particular treatment (the period is a slight different depending on the textbooks though). If your child's navel continues to bulge after those years, you have to consider the surgery.
However, the surgery need to be performed immediately if the small bowel get caught in the narrow space of the protruding navel and it causes ischemia. Also, it should be operated right away if umbilical hernia is getting larger or it is already larger than 2cm, since it is unlikely to close by itself. If general anesthesia is required for other operations, for instance inguinal hernia, the umbilical hernia surgery is performed together.
The surgery is performed by opening a circle around the navel and confirming the defected abdominal wall and sewing it firmly.
If it appears when he/she is an adult,
If the abdominal wall around the navel is defected or weak, umbilical hernia may occur when the child become an adult, or when the abdominal pressure increases or the abdominal wall becomes weak when he/she got old.
In the case of the abdominal pressure increases
=> Obesity, Pregnancy, Peritoneal dialysis, and Ascites caused by liver disease
In the case of the abdominal wall becomes weak
=> Old age, after open or laparoscopic surgery
In order to strengthen the abdominal wall, the artificial membrane(Mesh), which is rarely used in the surgery for children, is used in the adult umbilical hernia surgery.
Today, I covered the umbilical hernia of infants and young children.
I can say the bottom line is that ' don't worry too much because he/she gets better when they grow up! ' . However, it is necessary to see the doctor to make the accurate diagnosis and the treatment.
- Reference : Sabiston Textbook of Surgery 19th edition