UMBILICAL HERNIA

• An umbilical hernia is an outward bulging (protrusion) of the lining of the abdomen or part of the abdominal organs through the area around the umbilicus
• Patients (usually females) complain of abdominal swelling near to naval gradually increasing in size, becomes prominent on coughing or straining such as on strenuous exercise associated with intermittent dull ache

Types:

Umbilical Hernia of Newborn (Exomphalos)

• It is a developmental anomaly due to failure of whole or part of the mid-gut to return into the abdominal cavity during early foetal life. Abdominal organs remain protruded and being covered by a membrane – which consists of an outer layer of amniotic membrane, a middle layer of Wharton’s jelly and an inner layer of peritoneum
• Exomphalos minor - Where the sac is relatively small and its summit is attached the umbilical cord
• Exomphalos major - Umbilical cord is attached to the inferior aspect of a large swelling containing small and large intestine and a portion of the liver

Umbilical hernia in infants & children

• Hernia through a weak umbilical scar which occurs as a complication of umbilical sepsis
• It is a true umbilical hernia containing either omentum / intestines

Umbilical hernia of Adults (Para umbilical hernia)

• It is not a true umbilical hernia but it is a para umbilical protrusion through the linea alba just above the umbilicus (supra umbilical) or occasionally below the umbilicus (infra-umbilical)
• Contents are Greater omentum, Small intestine or Transverse colon

Exomphalos

• Developmental

Para umbilical hernia

• Sex – women are more affected than males
• Age – obese patients above 40 years of age
• Predisposing features – obesity, flabbiness of the abdominal muscles, repeated pregnancy

Umbilical hernia in infants and children:

• Usually symptomless
• Increases in size during crying
• Occurs more often in males than in females (2:1)
• Small hernia are spherical in size, increase in size to assume a conical shape
• Strangulation is rare

Paraumbilical hernia:

• Pain and swelling which increases on straining or coughing
• Pain gets worse by prolonged standing or heavy exercise
• Pull on the omentum often gives rise to gastrointestinal symptoms
• Transient attacks of intestinal colic may be present as there may be sub acute intestinal obstruction
• Reducibility can be present

Paraumbilical hernia - O/E

• Position – bulge of hernia is mostly just above the umbilicus through the linea alba or occasionally below the umbilicus through the midline
• Consistency – lump is firm, on percussion – dull, if it contains small bowel – resonant
• When the contents are not adherent, hernia becomes reducible, expansile cough impulse also becomes evident
• When contents are adherent, it becomes irreducible and impulse on coughing is absent

Exomphalos minor

• Twist to the cord may reduce the contents of the sac into the peritoneal cavity and this is retained by strapping firmly for a period of fortnight

Exomphalos major

• Operative management - otherwise sac will burst
• Intravenous blood transfusion and fluid therapy is advisable
• Use of broad spectrum antibiotic

Umbilical hernia in infants and children

• 90% cases are spontaneously cured within 12 to 18 months
• Reassurance to patients
• Coin bandage
• Operative – if it fails to disappear after 18 months

Paraumbilical hernia

• Operative management – Mayo’s operation
• Post operatively – care to relieve the cough, or from other causes of increased intra abdominal pressure

Ayurvedic Treatment

Internal medicines

• Gandharvahasthadi Kashaya
• Ullivettudakaadhi Kashaya
• Sukumara erandam

Procedure

• Reduce hernia and do Sthagika Bandha
• Pichu - Dhanawantara taila
• Matravasthi - Dhanwantara taila