Umbilical Hernia

Aka: Umbilical Hernia, Paraumbilical Hernia

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II. Epidemiology

  1. Prevalence: 10-30%

III. Pathophysiology

  1. Type of Ventral Hernia
  2. Infants
    1. Congenital defect in linea alba (failure to close completely at birth)
    2. Umbilical ring usually closes by age 12-18 months
    3. Repair is rarely recommended under age 3 years
    4. Regardless of Hernia size, 89% spontaneously close by age 5 years
      1. He (2024) JAMA Pediatr 178(5): 497-8 [PubMed]
  3. Adults (Paraumbilical Hernia): Predisposing factors
    1. Women with Multiparity
    2. Obesity
    3. Cirrhosis with Ascites
    4. Increased intrathoracic pressure (e.g. Asthma, COPD)
    5. African american

IV. Signs

  1. Congenital Hernia protrudes through firm collar
    1. Complete fibrous collar continuous with linea alba
    2. Palpable as firm ring
  2. Adult Paraumbilical Hernias
    1. Soft Hernia covered only by skin
    2. May be obscured by subcutaneous fat

V. Differential Diagnosis

  1. Diastasis Recti

VI. Complications

  1. High risk of Incarcerated Hernia (especially men and Overweight women)
    1. Incarceration typically with preperitoneal fat
    2. Large Umbilical Hernias may entrap Large Bowel

VII. References

  1. Degowin (1987) Diagnostic Examination, p. 489-96
  2. Goroll (2000) Primary Care Medicine, p. 431-433
  3. Stevens (2013) Crit Dec Emerg Med 27(9): 2

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