Diagnosis

Umbillical hernia

Etiology

Cause [4tu]

• Ascites

• Obesity

• Repeated pregnancies

• Connective tissue disease

• Congenital (10%)

• Connective tissue disorders

• Poor nutrition

Pathophysiology [4tu]

1. Obesity/ascites --> elevated intra-abdominal pressure

2. Stretching of the abdominal musculature --> separates muscle fibers and weaken the aponeuroses

3. Umbilical hernias occur at the fascial weakness in the thinned linea alba adjacent to the umbilicus where the umbilical vein penetrate the abdominal wall

4. In infants, umbilical hernias occur in 10% to 15% of cases and often resolve spontaneously by age 2

5. Clinical manifestation:

   • Usually asymptomatic periumbilical bulge

   • Pain during exercise

Complications [4tu]

• 65% will require surgical repair

• 4% require emergency intervention due to incarceration or strangulation the bowel and/or omentum

• Surgical complications: surgical site infections, hematoma, early recurrence, seroma, bowel injury, foreign body reaction, mesh infection or migration

Epidemiology

Prevalence per 100.000 [pmi][krg][4tu]

Approach

• Clinical diagnosis: Palpation

• Blood gas

• Ultrasound abdomen

• CT abdomen

• MRI abdomen

Treatment

1. Nonoperative management:

   • Smoking cessation

   • Weight reduction

   • Hernia belt

2. Surgical repair: if symptomatic or enlarging hernia larger than 2 cm in diameter [4tu]

   • Laparoscopic and robotic repair with mesh

   • Open surgery with or without mesh

3. Umbilical herniorrhaphy can be performed using various surgical techniques and may involve the use of synthetic or biologic mesh, depending on the size of the hernia, patient-specific factors, and the presence of contamination.

Differential diagnoses

Abdominal abscess, Desmoid, Granuloma, Hemangioma, Hematoma, Incisional hernia, Keloid, Lipoma, Lymphoma, Rectus diastasis, Rectus sheath hematoma