What is it? Umbilical hernias form when the umbilical ring is delayed in closing/fails to close completely. More common in: premature infants, low weight infants, children of African descent, hypothyroidism, children with certain syndromes e.g. T21 (Down syndrome)
How does it present? Most commonly presents as a reducible painless bulge at umbilicus. Can be more prominent when the baby or child strains or cries.
How to assess:
Thorough history: Exclude red flag symptoms of vomiting/constipation.
Systematic examination: particularly looking to exclude red flag signs of pain on examination, irreducibility of hernia & colour change of overlying skin.
Red flags: The following complications are extremely rare in umbilical hernias.
- Incarceration: when abdominal viscera/omentum become stuck within the hernia. Usually presents with: painful irreducible hernia, which can have overlying skin colour changes.
- Strangulation: when viscera become stuck in the hernia with compromise to their blood supply causing ischaemia. Usually present with: painful irreducible hernia, associated vomiting/constipation.
When/who to refer to?
- If symptoms of incarceration/strangulation – emergency referral is required for assessment by paediatric team in A&E/PAU. The paediatric team will assess and liaise with the paediatric surgical team (usually at St George’s Hospital) as necessary.
- Asymptomatic umbilical hernia in children <4 yrs old – reassure parents that complications are rare and most hernias will close by 4 years old.
- Asymptomatic umbilical hernia in children >4 yrs old – routine referral to paediatric surgeon required as spontaneous closure less likely as child grows older. This can be to the Paediatric Surgical clinic at Kingston Hospital, or to Paediatric Surgery at St George’s Hospital.