Umbilical Hernia In Children

Umbilical hernias are commonly found in infants and children. An umbilical hernia is a bulge of intra-abdominal organs through an opening in at the base of the umbilicus (belly button). – Dr. Ramsey Mustafa Al-Omari, Pediatric and Neonatal Consultant at Canadian Specialist Hospital, Dubai

This occurs when abdominal muscles fail to come together forming an opening called an umbilical ring. The size of umbilical hernias varies from child to child. Many umbilical hernias close on their own by 3 to 4 years of age.

1. What are the complications of umbilical hernia in children?

• Very few complications are associated with having an umbilical hernia. However, parents should be aware of some signs and symptoms & should see the doctor in case of any of the following :
• Pain from the hernia
• Discolouration of the hernia
• A hernia that cannot be pushed back into the abdominal cavity when child is relaxed
• A hernia that looks different than before

Complications:

• Obstruction: This happens when a bowel portion is part of the hernia contents and become obstructed at the hernial ring which leads to proximal bowel dilatation manifesting as persistent vomiting and failure to feed.
• Strangulation: Herniated contents may lose their blood supply as the Umbilical ring becomes severely constricted and may perforate leading to systemic sepsis and tissue necrosis.
• Incarceration: Contents may become incarcerated and irreducible with no symptoms of obstruction or strangulation.

2. What are the available remedies for treating hernia?

• It is generally recommended to wait for the hernia to close on its own. Usually, as the child grows, and the abdominal muscles strengthen, the hernia closes off naturally. This usually happens by the age of 3-4 years, if not sooner. Techniques such as taping or strapping a coin on the umbilicus to close the hernia are not effective and are not recommended and may cause skin irritation or infection. Furthermore, special massages can cause more damage as there is no supportive evidence of its effectiveness. An operation is the only recommended way to repair a hernia that has not closed on its own. Indications for surgery include persistence of hernia beyond the age of 4 years and complications like obstruction or strangulation. Hernia repair is carried out using an appropriate absorbable suture closing the defect in the anterior abdominal wall with open technique.

3. What is the cure rate?

• In majority of the cases, hernia less than 1 cm in diameter closes on its own & resolves before the age of 3-4 years. This happens as the abdominal wall gains strength and the umbilical ring closes. In children where watchful waiting has not yield the desired closure by 4 years of age, then surgical repair is indicated.

4. Does umbilical hernia reappear after treatment, and why?

• Studies have shown that less than 1% of repaired umbilical hernias recur. Recurrence of the hernia is rare and may appear because of post-operative complications due to wound infection (incidence 7 in 1000 repairs) & a hematoma formation (collection of blood ) at operation site ( incidence 6 in 1000 repairs).

5. What are the preventive ways to avoid umbilical hernia in children?

• There are no recommended ways of preventing umbilical hernia in children. They are more prevalent in premature babies, babies with Down’s syndrome and babies with other congenital abnormalities. Liaison with a pediatric surgeon is necessary in complex cases.