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Complicated umbilical hernia in childhood
R A Brown1, A Numanoglu, H Rode
1Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, School of Child and Adolescent Health, University of Cape Town.
Insights
Complicated umbilical hernias in children are rare but serious, often presenting with pain and vomiting. Prompt surgical intervention is recommended for irreducible umbilical masses to prevent complications like bowel obstruction.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Umbilical hernias are common in pediatric populations.
- Complications associated with umbilical hernias are infrequently reported.
Purpose of the Study:
- To determine the incidence of complicated umbilical hernias in children.
- To identify risk factors for umbilical hernia complications.
- To review management strategies for complicated umbilical hernias.
Main Methods:
- Prospective study of children requiring umbilical hernia repair for complications over 15 years.
- Exclusion of patients with para-umbilical and other ventral wall hernias.
- Data collection on symptoms, age, and radiological findings.
Main Results:
- 28 out of 389 (7%) children undergoing umbilical hernia repair had complications.
- Common symptoms included umbilical pain (100%), vomiting (71%), and constipation (28%).
- Radiological evidence of small-bowel obstruction was found in 11 children, and pica in 5; 2 patients required omentum resection.
Conclusions:
- Complicated umbilical hernias, though rare, present with significant symptoms like pain and vomiting.
- Prompt surgical repair is crucial for pediatric patients with localized abdominal pain or irreducible umbilical masses.
- Early surgical intervention can prevent serious complications such as bowel obstruction.
Abstract:
Umbilical hernias occur frequently in children but complications are rarely reported. This study assessed the incidence of complicated umbilical hernias in our patients, evaluated data for risk factors and reviewed our management in the light of these findings. We conducted a prospective study of all children needing umbilical hernia repair for complications over a period of 15 years. Patients with para-umbilical and other ventral wall hernias were excluded. In total, 389 children had umbilical hernias repaired during this period (average age 6 years); 28 (7%) of these had complicated hernias. Symptoms included umbilical pain (100%), vomiting (71%) and constipation (28%). The average age of the complicated group was 3 years. All cases had a painful irreducible umbilical mass. Eleven of the 19 children who had an abdominal radiograph showed radiological evidence of small-bowel obstruction and in 5 children there was radiological evidence of pica. Two patients had ischaemic omentum that required resection. Patients who present with localised abdominal pain or an irreducible umbilical mass should be operated on promptly.
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