UMBILICAL HERNIA

Definition

• Umbilical hernia is the protrusion of abdominal contents through a weak area at the umbilical ring.

Anatomy Involved

• Umbilical ring
• Linea alba
• Rectus sheath
• Peritoneum
• Omentum or intestine

Boundaries of Umbilical Ring

• Superior → Linea alba
• Inferior → Linea alba
• Medial → Fibrous umbilical ring
• Lateral → Rectus sheath
• Anterior → Skin and subcutaneous tissue
• Posterior → Peritoneum

Types of Umbilical Hernia

1. Congenital Umbilical Hernia

• Occurs in infants
• Due to failure of closure of umbilical ring
• Usually small
• Often closes spontaneously by 2–3 years

2. Acquired Umbilical Hernia

• Occurs in adults
• Due to weakness of abdominal wall
• Common in obese and multiparous women

3. Paraumbilical Hernia

• Occurs just above or below the umbilicus
• Most common type in adults
• Often large
• High risk of strangulation

4. Infantile Umbilical Hernia

• Seen in newborns and infants
• Wide umbilical ring
• Low risk of complications

5. Obstructed Umbilical Hernia

• Hernial contents cannot be reduced
• Intestinal obstruction may occur

6. Strangulated Umbilical Hernia

• Blood supply to contents is compromised
• Surgical emergency

Causes / Risk Factors

• Congenital weakness of umbilical ring
• Obesity
• Multiple pregnancies
• Ascites
• Chronic cough
• Constipation
• Heavy lifting
• Poor muscle tone

Clinical Features of Umbilical Hernia

• Swelling at or near umbilicus

• Swelling increases on coughing or straining

• Reducible in early stages

• Pain or discomfort at umbilicus

• Feeling of heaviness

• Skin over swelling may become thin

• In strangulation

  • Severe pain
  • Redness of skin
  • Vomiting
  • Abdominal distension

Physical Examination

• Central abdominal swelling at umbilicus
• Cough impulse present
• Reducibility assessed
• Head-raising test increases prominence
• Tenderness suggests complications

Diagnosis of Umbilical Hernia

• Clinical examination is sufficient in most cases
• Ultrasound abdomen
• CT scan for large or complicated hernias
• X-ray abdomen if obstruction suspected

Differential Diagnosis

• Paraumbilical hernia
• Epigastric hernia
• Lipoma
• Umbilical granuloma

Complications

• Incarceration
• Obstruction
• Strangulation
• Ulceration of skin
• Recurrence

Management

Conservative Management

• Suitable for infants
• Observation till 2–3 years
• Treat cough and constipation
• Weight reduction

Surgical Management

• Indicated in adults
• Herniotomy with repair
• Mesh repair for large defects
• Emergency surgery in strangulation

Surgical Principles

• Reduction of hernial contents
• Excision of sac if needed
• Closure of defect
• Mesh reinforcement if large defect

Homoeopathic Therapeutic Approach

• Calcarea carbonica → Umbilical hernia in obese patients
• Lycopodium → Abdominal weakness
• Nux vomica → Hernia due to strain and constipation
• Silicea → Weak tissues and delayed healing
• Arnica → Pain after strain

Important Points

• Common in infants and adult females
• Paraumbilical hernia has higher complication risk
• Surgery is definitive treatment in adults