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Umbilical Hernia

Umbilical hernias can be congenital or acquired. Congenital umbilical hernias are malformations of the umbilicus or navel region. A more common occurrence in women, umbilical hernia, is caused due to increased intra-abdominal pressure. Congenital umbilical hernias occur through the umbilical fibromuscular ring in children. They usually obliterate by two years of age but in the case of persistence for more than 2 – 4 years, surgical intervention may be required. Premature infants are at a higher risk of developing umbilical hernias.

Causes

  • Too much intra-abdominal pressure

  • Obesity

  • Frequent pregnancies

  • Multiple gestations such as triplets, twins etc.

  • Ascites or accumulation of fluid in the abdominal cavity

  • Abdominal surgery

  • COPD – persistent and heavy coughing

Signs and Symptoms

Congenital umbilical hernias are noticed when there is a swelling or bulge around the navel area especially when the baby cries or strains. The swelling disappears when the baby is lying down on its back. Congenital umbilical hernias are not painful. A hernia can be serious if there is pain, and the patient experiences vomiting. The bulge becomes swollen, discoloured and is tender on palpation. Adult umbilical hernias can cause a lot of abdominal discomfitures.

Diagnosis

  • Physical examination will reveal a swelling at the site along with some sensation of aching that radiates into the area of the hernia. Children display irritability if the hernia is really large. Hernias are usually accompanied by a dull pain that can worsen with exercise or any kind of strain. An incarcerated hernia is a painful enlargement. There is evident nausea, vomiting and possible bowel obstruction. In case of a strangulated hernia, there is a toxic appearance secondary to ischemic bowel.

  • Blood tests will include CBC, blood urea nitrogen and electrolyte levels.

  • Other tests such as lactate levels and urinalysis are also conducted.

  • Abdominal films, chest radiographs, CT of the abdomen and pelvis and ultrasound scans are also taken.

Treatment and Medication

Hernias require surgery especially because of the risk of a strangulated bowel. These demand admission and surgical evaluation. In adults, the omentum is a frequently incarcerated organ. Broad spectrum antibiotics are prescribed for suspected bowel ischemia. Local anaesthetics such as lidocaine and epinephrine will give patient comfort during the procedure. Propophol and Thiopental are general anaesthetics that are used when required. NSAIDs are anti-inflammatory drugs and anti-anxiety drugs will reduce patient agitation before a surgery.

Dr. Deepak is a bariatric surgeon who has effectively conducted a number of surgeries for hernias successfully.

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