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Incarceration of umbilical hernias in children: a rare but important complication
S Papagrigoriadis1, D J Browse, E R Howard
1Department of Paediatric Surgery, King's College Hospital, Denmark Hill, London SE5 9RS, U.K.
Insights
Umbilical hernias (UH) in children usually close on their own. While rare, incarceration can occur, sometimes due to undigested food, necessitating awareness of early symptoms.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Umbilical hernia (UH) is a frequent pediatric condition, particularly in Afro-Caribbean infants.
- Most umbilical hernias resolve spontaneously before age 4, unless the sac neck exceeds 2 cm.
Purpose of the Study:
- To report on incarcerated umbilical hernias in young boys.
- To highlight potential causes and the safety of conservative management for UH.
Main Methods:
- Case series of three boys under 4 years old with incarcerated umbilical hernias.
- Literature review on the incidence of UH complications.
Main Results:
- All three cases presented with small-bowel obstruction.
- Undigested vegetable matter was implicated in the obstruction in two cases.
- Literature suggests an incidence of incarcerated UH complications around 1:1,500.
Conclusions:
- Conservative management of umbilical hernia is safe for most children.
- Parents and practitioners should recognize early signs of incarceration, a rare but serious complication.
Abstract:
Umbilical hernia (UH) is a common condition in infants and young children, especially in those of Afro-Caribbean origin. Spontaneous closure occurs in a majority of cases before the age of 4 years unless the neck of the sac is greater than 2 cm in diameter. Complications are rare, and conservative management is therefore advised during this time. We present three cases of incarcerated UH in boys under 4 years old, all of whom presented with small-bowel obstruction. Interestingly, in two of them undigested vegetable matter in the small bowel appeared to have precipitated the obstruction. A survey of the literature suggests that the incidence of this complication is approximately 1:1,500 UHs. We conclude that the present policy of expectant management is safe for the vast majority of children, but parents and general practitioners should be aware of the small risk and early symptoms of incarceration.