Is your baby's belly button bulging? Please keep this umbilical hernia prevention and treatment manual

Author: Xing Xiaowei, attending physician, Beijing Chaoyang Hospital, Capital Medical University

Reviewer: Shin Youngmo, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

Umbilical hernia, as a common type of extra-abdominal hernia, ranks fourth in incidence among extra-abdominal hernias, second only to inguinal oblique hernia, inguinal direct hernia and abdominal wall incisional hernia. Umbilical hernia refers specifically to a hernia formed in the navel area. Due to the weakness of the abdominal wall in the navel area, the organs in the abdominal cavity protrude through this defect, forming a visible mass.

Figure 1 Original copyright image, no permission to reprint

The formation of umbilical hernia is mainly due to the weakness of the abdominal wall in the navel area. During fetal development, the navel is the last part of the abdominal wall to close, retaining structures such as the umbilical artery, umbilical vein and urachus to facilitate nutrient exchange and waste excretion with the mother. After birth, with the ligation and shedding of the umbilical cord, the navel gradually closes, but this area often becomes a weak point on the abdominal wall. Therefore, when the intra-abdominal pressure increases, such as when infants and young children cry or when adults have high abdominal pressure, the abdominal organs are likely to protrude through this weak point, forming an umbilical hernia.

Umbilical hernias can be divided into pediatric umbilical hernias and adult umbilical hernias based on pathology and etiology. Umbilical hernias in children, especially in infants and young children, are extremely common in pediatric surgery, with an incidence rate of 2%-20%, or even higher. This is mainly because the umbilical cord plays an important role in fetal development and is one of the important channels connecting the mother and the fetus. Therefore, it becomes the most vulnerable part of the abdominal wall after birth. In contrast, adult umbilical hernias are more common during female pregnancy or in special circumstances such as ascites due to cirrhosis. Umbilical hernias occur due to a significant increase in abdominal pressure.

When diagnosing umbilical hernia, doctors mainly rely on the patient's clinical manifestations and physical examination. A typical umbilical hernia manifests as a protruding mass in the navel area, which is more obvious when the abdominal pressure increases, such as when an infant cries. In addition, doctors will check the size and degree of defect of the umbilical ring through palpation to further confirm the diagnosis. For cases that are difficult to diagnose, imaging examinations such as B-ultrasound or CT can provide more accurate diagnostic information.

The symptoms of umbilical hernia vary depending on the contents of the hernia. In most cases, the contents of the umbilical hernia are the omentum, and the patient may only experience dull pain or a pulling sensation in the upper abdomen. If the hernia contents are intestinal, especially the small intestine, it may cause more obvious gastrointestinal symptoms, such as nausea, vomiting, and abdominal distension. In rare cases, if the hernia becomes incarcerated or strangulated, it may lead to serious complications such as intestinal obstruction and require emergency treatment.

When it comes to the treatment of umbilical hernias in infants and young children, doctors usually adopt the principle of conservative treatment. Unless there is an emergency such as hernia incarceration or rupture, in most cases, doctors will recommend close observation of the development of the umbilical hernia within 2 years of age.

During this period, parents should follow the doctor's advice and take a series of measures to help prevent the further development of hernia, such as avoiding letting the child cry for a long time and promptly treating constipation, colds and other symptoms to avoid increasing abdominal pressure. In addition, some external fixation devices, such as special umbilical hernia belts or tape fixation, can be used to help maintain the normal shape of the belly button and promote natural healing.

Figure 2 Original copyright image, no permission to reprint

It is worth noting that if the umbilical hernia has not closed by itself by the age of 2, surgical treatment should be considered. The surgery usually adopts the traditional open surgery method, tries to preserve the appearance of the navel, and uses general anesthesia or intravenous anesthesia when necessary to ensure the smooth operation.