Infant umbilical/ventral hernia

For embryonic defects, see main 'umbilical hernia' topic

Very common in infants and young children

Aetiology

• Failure of complete obliteration at the site where the fetal umbilical vessels enter the abdo wall

Presentation

• Becomes more obvious during periods of distress/crying
• Can protrude significantly
• Rupture/incarceration is really uncommon
• Rarely a cause of symptoms

Natural history

• 80% will decrease in size and close spontaneously by 4yo

Indications for repair

• Hernia defects that do not close by 4 years of age
• Could be done earlier if defect is >2cm (less likely to close), but not before 3 years old if asymptomatic due to anaesthesia risks

Epigastric hernias

• Failure of fixation of the medial borders of the rectus abdominis at linea alba can often result in impressive diastasis/divarication
• This is of virtually no consequence, and will resolve spontaneously
• Smaller focal defects in epigastrium, on the other hand, can often by symptomatic and even incarcerate
  • Won't spontaneously close
  • Can be repaired on an elective basis if symptomatic