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rupture in smooth muscle tissue through which a bodily structure protrudes (同)herniation
relating to or resembling the umbilicus; "umbilical cord"

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ヘルニア,脱腸
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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/10/13 15:22:21」(JST)

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Congenital umbilical hernia is a congenital malformation of the navel (umbilicus). Among adults, it is three times more common in women than in men; among children, the ratio is roughly equal.^[1] It is also found to be more common in children of African descent. An acquired umbilical hernia directly results from increased intra-abdominal pressure caused by obesity, heavy lifting, a long history of coughing, or multiple pregnancies.^[2]

Signs and symptoms

A hernia is present at the site of the umbilicus (commonly called a navel, or belly button) in the newborn; although sometimes quite large, these hernias tend to resolve without any treatment by around the age of 2–3 years.^[3]^{[citation needed]} Obstruction and strangulation of the hernia is rare because the underlying defect in the abdominal wall is larger than in an inguinal hernia of the newborn. The size of the base of the herniated tissue is inversely correlated with risk of strangulation (i.e. narrow base is more likely to strangulate).

Babies are prone to this malformation because of the process during fetal development by which the abdominal organs form outside the abdominal cavity, later returning into it through an opening which will become the umbilicus.

Differential diagnosis

Importantly this type of hernia must be distinguished from a paraumbilical hernia, which occurs in adults and involves a defect in the midline near to the umbilicus, and from omphalocele.

Treatment

When the orifice is small (< 1 or 2 cm), 90% close within 3 years (some sources state 85% of all umbilical hernias, regardless of size^[4]), and if these hernias are asymptomatic, reducible, and don't enlarge, no surgery is needed (and in other cases it must be considered). In some communities mothers routinely push the small bulge back in and tape a coin over the palpable hernia hole until closure occurs. This practice is not medically recommended as there is a small risk of trapping a loop of bowel under part of the coin resulting in a small area of ischemic bowel. This "fix" doesn't help and germs may accumulate under the tape, causing infection. The use of bandages or other articles to continuously reduce the hernia is not evidence-based.

An umbilical hernia can be fixed in two different ways. The surgeon can opt to stitch the walls of the abdominal or he/she can place mesh over the opening and stitch it to the abdominal walls. The latter is of a stronger hold and is commonly used for larger defects in the abdominal wall. Most surgeons will not repair the hernia until 5–6 years after the baby is born. Most umbilical hernias in infants and children close spontaneously and rarely have complications of gastrointestinal content incarcerations.^[5]

The amount of projection of the swelling varies from child to child. In some, it may be just a small protrusion; in others it may be a large rounded swelling that bulges out when the baby cries. This may hardly be visible when the child is quiet and or sleeping. Normally, the abdominal muscles converge and fuse at the umbilicus during the formation stage, however, in some cases, there remains a gap where the muscles do not close and through this gap the inner intestines come up and bulge under the skin, giving rise to an umbilical hernia. The bulge and its contents can easily be pushed back and reduced into the abdominal cavity.

In contrast to an inguinal hernia, the complication incidence is very low, and in addition, the gap in the muscles usually closes with time and the hernia disappears on its own. The treatment of this condition is essentially conservative - observation allowing the child to grow up and see if it disappears. Operation and closure of the defect is required only if the hernia persists after the age of 3 years or if the child has an episode of complication during the period of observation like irreducibility, intestinal obstruction, abdominal distension with vomiting, or red shiny painful skin over the swelling. Surgery is always done under anesthesia, and the defect in the muscles is defined and the edges of the muscles are brought together with sutures to close the defect. The child needs to stay in the hospital for 2 days and the healing is complete within 8 days.

At times, there may be a fleshy red swelling seen in the hollow of the umbilicus that persists after the cord has fallen off. It may bleed on touch, or may stain the clothes that come in contact with it. This needs to be shown to a pediatric surgeon. This is most likely to be an umbilical polyp and the therapy is to tie it at the base with a stitch so that it falls off and there is no bleeding. Alternatively, it may be an umbilical granuloma that responds well to local application of dry salt or silver nitrate but may take a few weeks to heal and dry.^[6]

References

^ "eMedicine - Abdominal Hernias : Article by Eustace S Golladay". Retrieved 2007-10-16.
^ Mayo Clinic staff. "Umbilical hernia: Causes - MayoClinic.com". Retrieved 2010-03-31.
^ Lissauer, Tom; Clayden, Graham (2007). Illustrated Textbook of Paediatrics (3rd ed.). Edinburgh: Mosby Elsevier. ISBN 978-0-7234-3397-2.
^ "Umbilical Hernia - DrGreene.com". Retrieved 2007-10-16.
^ Papagrigoriadis, S., and E. R. Howard. "Incarceration of umbilical hernias in children: a rare but important complication." Pediatric surgery international 14.3 (1998): 231-232.
^ "Child with Umbilical Swellings/Hernia". Retrieved 2013-10-10.

External links

Overview at Cincinnati Children's Hospital Medical Center
Overview at Penn State

UpToDate Contents

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1. 成人における腹壁ヘルニアの概要 overview of abdominal wall hernias in adults
2. 臍のケアおよび臍の異常のマネージメント care of the umbilicus and management of umbilical disorders
3. 成人における肝硬変：合併症、全般的マネージメント、および予後の概要 cirrhosis in adults overview of complications general management and prognosis
4. 婦人科腹腔鏡下手術の概要および非経臍帯的進入 overview of gynecologic laparoscopic surgery and non umbilical entry sites
5. 腹壁ヘルニア修復後の創傷感染 wound infection following repair of abdominal wall hernia

English Journal

A case of dichorionic twin pregnancy concordant for bilateral cleft lip and palate and discordant for spina bifida; schisis association.

Kutuk MS, Ozgun MT, Uludag S, Akgun H, Balta B.SourceDepartment of Obstetrics and Gynecology.
Fetal and pediatric pathology.Fetal Pediatr Pathol.2013 Oct;32(5):371-4. doi: 10.3109/15513815.2013.789946. Epub 2013 Apr 22.
Backround: The schisis theory suggests that neural tube defect (NTD), cleft lip and palate (CL/P), omphalocele and diaphragmatic hernia are associated to each other more frequently than at the expected random combination rates in a given fetus. However, it is unusual to see schisis-associated defect
PMID 23607868

Pediatric abdominal wall defects.

Kelly KB, Ponsky TA.SourceDivision of Pediatric Surgery, Pediatric Surgery Center, Akron Children's Hospital, One Perkins Square, Akron, OH 44308, USA.
The Surgical clinics of North America.Surg Clin North Am.2013 Oct;93(5):1255-67. doi: 10.1016/j.suc.2013.06.016. Epub 2013 Jul 26.
This article reviews the incidence, presentation, anatomy, and surgical management of abdominal wall defects found in the pediatric population. Defects such as inguinal hernia and umbilical hernia are common and are encountered frequently by the pediatric surgeon. Recently developed techniques for r
PMID 24035087

Repair of umbilical and epigastric hernias.

Earle DB, McLellan JA.SourceDepartment of Surgery, Baystate Medical Center, Springfield, MA 01199, USA; Tufts University School of Medicine, Boston, MA, USA. Electronic address: david.earle@baystatehealth.org.
The Surgical clinics of North America.Surg Clin North Am.2013 Oct;93(5):1057-89. doi: 10.1016/j.suc.2013.06.017.
Umbilical and epigastric hernias are primary midline defects that are present in up to 50% of the population. In the United States, only about 1% of the population carries this specific diagnosis, and only about 11% of these are repaired. Repair is aimed at symptoms relief or prevention, and the pat
PMID 24035076

Japanese Journal

臍ヘルニア・臍突出症に対する外科的治療 (特集臍の形成術)

野口昌彦,安永能周
形成外科 56(1), 27-35, 2013-01-00
NAID 40019548351

臍ヘルニア・臍突出症に対する保存的治療 (特集臍の形成術)

関堂充
形成外科 56(1), 19-25, 2013-01-00
NAID 40019548346

Related Pictures

★リンクテーブル★

リンク元	「臍ヘルニア」「臍帯ヘルニア」
関連記事	「umbilical」

「臍ヘルニア」

Umbilical hernia
	Children with umbilical hernias, Sierra Leone (West Africa), 1967.
Classification and external resources
Specialty	gastroenterology
ICD-10	K42
ICD-9-CM	551-553
DiseasesDB	23647
MedlinePlus	000987
MeSH	D006554