Pediatric Umbilical Hernia

Excerpt

Umbilical hernias typically manifest as a noticeable bulge in the area surrounding the navel in a newborn baby, which becomes more evident when the infant cries or exerts pressure. This is a frequent observation made during the routine well-baby checkups with a pediatrician in the first months of a baby's life.

First-time (or inexperienced) parents may express significant concerns during these visits when they notice a protrusion in their infant's belly button, as they are often unfamiliar with this phenomenon and tend to become anxious. Moreover, parents might be concerned about the possibility of their child experiencing severe complications due to an umbilical hernia, leading them to question whether there are any preventive measures they should undertake to mitigate these risks.

Clinicians should effectively educate parents on the condition's natural progression, as more than 90% of umbilical hernias in neonates and young children are asymptomatic, and they typically resolve spontaneously by the age of 5 or earlier. Parents of the infants should also receive guidance regarding the indications for potential early intervention and be educated on how to recognize signs that may indicate incarceration or strangulation of the umbilical hernia.

Anatomy

The umbilicus is composed of 4 components:

1. Cicatrix refers to the dense and thick scar tissue deep within the umbilical center. It represents the convergence of various fetal mesodermal layers, including the round hepatic ligament, median umbilical ligaments, parietal and transversalis fascia, umbilical fascia, and peritoneum.

2. The cushion is a slightly raised ridge that forms the circumferential margin of the umbilicus.

3. Furrows form the creases and depression within the umbilicus.

4. Mamelon represents the area of the central hump, bulge, or umbilical depression.

The shape of the umbilicus at birth may hold some influence and predictive value in the development of persistent pediatric umbilical hernias. More than 60 normal anatomical variations have been identified. A particular study revealed that individuals with a protruding or crescent-shaped umbilicus had a higher risk of developing umbilical hernias than those with the more common concave shape.