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Umbilical and Paraumbilical Hernia (Umbilical (Risk Factors (Afro…
Umbilical and Paraumbilical Hernia
Examination
Inspection
Pt. may be overweight
Ask pt. to lift head off bed and to cough
Note any associated skin damage: e.g. ulceration
Note any overlying scars: may indicate recurrence
Palpation
Any tenderness?
Feel for presence of defect
Try to asses size
Ask pt. to cough while feeling for an impulse
If a lump is present, ask pt. to reduce it.
Viva
Hx
Predisposing factors: pregnancy, ascites, obesity
Pain
Reducible
Episodes of obstruction or strangulation
Previous repairs
Paraumbilical
Pathogenesis
Acquired defect in the linea alba just above or below the umbilicus
Commoner in obese, middle-aged pts.
Neck is commonly narrow
Prone to becoming irreducible or strangulated
Typically contain omentum ± large or small bowel
May be large → necrosis of the skin
Risk Factors
Obesity
Pregnancy
Ascites
Fibroids
Bowel distension
Mx
Surgery advised due to high risk of strangulation
Rx concurrent medical problems
Mayo Repair
Mobilise sac and reduce contents
Double-breast the linea alba ± sublay mesh
Umbilical
Pathogenesis
Congenital defect in the umbilical scar (cicatrix)
Typically congenital: 3% of live births
Risk Factors
Afro-Caribbean
Trisomy 21
Congenital hypothyroidism
Can recur in adults: pregnancy, ascites
Mx
Usually asymptomatic and resolve by 2-3yrs
Surgical repair advocated if no resolution by 3yrs
Other Congenital Defects
Gastroschisis
Protrusion of abdo contents through defect in abdo wall
to the right of the umbilicus.
Not usually a/w other abnormalities
Prompt surgical repair after fluid resuscitation
Exomphalos
Protrusion of abdominal contents w/i in a 3-layered sac
Commonly a/w other defects: cardiac, anencephaly