Umbilical Hernia

    • Exomphalos (syn. omphalocele)
      • It is due to failure of all or part of the mid-gut to return to the coelom during early fetal life.
      • Sac is semi-translucent and very thin consisting of two layers, outer amniotic membrane and inner peritoneum.

Exomphalos minor

  • Sac is relatively small and to its summit is attached the umbilical cord
  • Treated by twisting the card so to reduce the contents and to retain them their by firm strapping for two weeks.
  • Exomphalos major
    • The umbilical card is attached to the inferior aspect of the swelling which contains small and large intestine and a portion of liver.
    • Early operated treatment is recommended under antibiotic cover
    • Large defects are manage by non-operative therapy, skin flap closure, stage closure and primary closure.
    • If sac content are not reduced without tension cover the sac with flaps of skin, and quit later repair the hernial defect.
  • Omphaloceles may be divided into those with a fascial defect less than 4 cm and those with a defect more than 4 cm. The farmer are termed herniation of the umbilical cord, and contains small gut only. In larger defect abdominal contents are visible and liver has dense adhesions to the sac

 Umbilical hernia

  • Congenital umbilical hernia
    • Present at birth presumably due to intrauterine epithelialisation of a small exomphalos.
  • Umbilical hernia of infants and children.
    • Hernia through a weak umbilicus, caused by incomplete closure of the umbilical ring or defect in development of abdominal muscles.
    • Obstruction or strangulation below  the age of three years is extremely uncommon.
    • Treatment is only operation (herniorrhaphy).
  • Paraumbilical hernia of adults
    • It is the untreated umbilical hernia of infants present at this age due to many factors raising the intra abdominal pressure.
    • Women are five times more affected than men.
    • Irreducible hernia having omental adhesions within the sac.
    • A large umbilical hernia may causes a local dragging pain by its weight
    • Gastrointestinal symptoms are common and are due to traction on the stomach and transverse colon
    • Strangulation may occur due to narrow neck of sac and fibrous edge of the linea alba, gangrene is liable to supervene unless early operation is carried out.
    • In large hernia the presence of loculi may result in strangulated knuckle of the bowel in one part of an otherwise soft and non-tender hernia.
  • Operation is treatment
    • In Mayo’s operation recurrence is high and it is against the normal anatomy
    • Do the vertical repair after denuding the margins and try to bring together the rectus abdominal muscles, reinforce the repair with proline mesh, put the drain.
    • Do additional lipectomy in patient having large pendulous, fat-laden abdominal wall.

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