Complicated umbilical hernias in children

Littre's Umbilical Hernia in a Child: A Case Report and Scoping Review

Littre's umbilical hernia (UH) is a rare disease, the third most common Littre hernia. Most case reports interest adult patients. We reported the case of a four-year-old girl with anemia and symptomatic UH, with an incidentally diagnosed Meckel's diverticulum (MD) containing pancreatic ectopic tissue. We reviewed case reports on Littre's umbilical hernia without a date or language restriction. Including our patient, 21 cases were reviewed, of whom 15 (71.4%) were adults and 13 (61.9%) were males. Complicated umbilical hernia occurred in 13 patients (61.9%) and symptomatic MD in two children (9.5%). Investigations preoperatively diagnosed two patients (9.5%). Eighteen patients (85.7%) underwent open surgery, Meckel's diverticulum removal was performed in 18 patients (85.7%), and primary umbilical hernia repair was performed in 16 (76.2%). Ectopic tissue was present in four patients (19.1%), and long-term outcomes were excellent in all patients.

Case Report: The acute appendicitis and incarcerated umbilical hernia: a rare association

Introduction

One of the most prevalent congenital wall abnormalities in children, umbilical hernias are often linked to premature or small-for-gestational-age babies. In cases of intestinal malrotation or if the cecum is very movable, generalized peritonitis may facilitate the imprisonment of these hernias.

Case report

We described a case of a 4-month-old baby who had a prior reducible umbilical hernia with a history of fever, vomiting, poor appetite, and constipation for around 48 h. The patient experienced significant intestinal bloating, vomiting, irreducibility of the umbilical hernia, skin pigmentation, and erythema at the umbilical site within 2 days after hospitalization. When there was no free abdominal air, a direct abdominal x-ray revealed evidence of hydro-gas stasis and various hydro-aerial levels that were pertinent to the ileum. In order to reduce the hernia, the patient had an emergency surgical treatment where the hernia sac was isolated and released from the ileal loop, which was securely attached to a fibrin plate. When the herniary sac was opened, a gangrenous and perforated appendix was found inside. On the seventh postoperative day, the patient was released from the hospital after an uncomplicated postoperative stay.

Conclusion

Our patient's clinical presentation is similar to that of only one other case report involving a 25-day-old male patient. Our case presented with a variant of the clinical symptoms of the previously described umbilical hernia, which became unfixable and strangulated as a result of appendix inflammation. The appendix was discovered inside the hernia sac during surgery.

Transumbilical repair of umbilical hernia in children: The covert scar approach

BACKGROUND

Umbilical hernia repairs are one of the most commonly performed operations in children. The traditional repair involves an infraumbilical incision, which produces a visible scar. We report a novel technique of umbilical hernia repair through a transumbilical incision, which eliminates the scar by hiding it within the umbilicus.

METHODS

We performed a retrospective chart review of 134 patients who had undergone a transumbilical hernia repair at a single institution between 2008 and 2016. Satisfaction with cosmesis and the presence of complications were assessed through parental interviews during follow up visit or by telephone survey. These data were compared to a large volume retrospective analysis of the standard infraumbilical approach.

RESULTS

121 of the 134 patients were evaluated in the clinic or by telephone interview. The overall complication rate was 7.44%. Parents of 118 patients reported satisfaction with the cosmetic result (97.52%). In comparison to the largest study of pediatric infraumbilical repair, there was an improvement in subjective cosmesis without a significant increase in complications.

CONCLUSION

Transumbilical hernia repair is a safe and cosmetically appealing technique for umbilical hernia repair in children.

LEVEL OF EVIDENCE

Treatment study, level III.

Management of asymptomatic pediatric umbilical hernias: a systematic review

INTRODUCTION

Uncomplicated pediatric umbilical hernias are common and most close spontaneously. No formal practice guidelines exist regarding the optimal timing and indications for repair. The objective of this review is to examine the existing literature on the natural history of pediatric umbilical hernias, known complications of repair and non-operative approaches, and management recommendations.

STUDY DESIGN

A systematic literature search was performed to identify publications relating to pediatric umbilical hernias. Inclusion criteria comprised studies addressing recommendations for optimal timing of repair, evidence examining complications from hernias not operatively repaired, and research exploring the likelihood of pediatric umbilical hernias to close spontaneously. In addition, the websites of all pediatric hospitals in the United States were examined for recommendations on operative timing.

RESULTS

A total of 787 manuscripts were reviewed, and 28 met criteria for inclusion in the analysis. Studies examined the likelihood of spontaneous closure based on child's age and size of hernia defect, complications of unrepaired umbilical hernias including incarceration, strangulation and evisceration based on child's age and size of defect, incidence of postoperative complications and current recommendations for timing of repair. In addition, 63 (27.5%) of the United States pediatric hospital websites published a wide range of management recommendations.

CONCLUSION

Despite the high prevalence of pediatric umbilical hernias, there is a paucity of high quality data to guide management. The literature does suggest that expectant management of asymptomatic hernias until age 4-5years, regardless of size of hernia defect, is both safe and the standard practice of many pediatric hospitals.

TYPE OF STUDY

Review Article.

LEVEL OF EVIDENCE

Level IV.

Omentum in the pediatric umbilical hernia: is it a potential alarm for the appearance of complications?

Umbilical hernia is a common benign condition which resolves spontaneously during the first five years of life. However, in certain cases there are some characteristics which may be indicative of a different prognostic approach, as they increase the possibility of complications. The two cases of umbilical hernia that we describe here were treated operatively and revealed the presence of strangulated and adhered omentum, respectively. Reflecting on the adhesive properties of the omentum, we hypothesized that this may occur more often than it is believed, especially in those cases that are described as recurrent symptomatic herniations. In such cases, there should be increased alert for the possibility of complications during the period of the conservative expectance for resolution.

A literature review of spontaneous evisceration in paediatric umbilical hernias

Umbilical hernias occur frequently in children but complications are very rare and thus surgery is not routinely indicated. In this literature review, we report 19 cases of spontaneous evisceration of abdominal contents through umbilical hernias. Precipitating causes included umbilical ulceration or sepsis, crying, respiratory infection, intussusception and ascites. Management involved resuscitation and surgical repair. Mortality is low. As the incidence of spontaneous rupture is very low, the current management of an umbilical hernia remains appropriate. However, we encourage physicians to be aware of the potential risk factors for spontaneous rupture and in these patients expedite surgical repair.

Spontaneous rupture of an infantile umbilical hernia with intestinal evisceration

Infantile umbilical hernia is a clinically benign condition that resolves spontaneously in majority of cases without surgical treatment. Complications like rupture are exceptionally rare. This report presents a previously healthy 8-month old infant who had spontaneous umbilical hernia rupture with evisceration and identifies the clinical features associated with this complication by including a review of previously reported cases.

An unusual case of umbilical hernia rupture with evisceration

Umbilical hernia is a common pediatric diagnosis for which the initial management is usually nonoperative. The high incidence of spontaneous closure and the infrequency of complications in the first few years of life justify this conservative management strategy. The authors present a case of a 5-month-old girl with a history of prematurity and prolonged ventilatory support, who subsequently experienced bowel evisceration via a previously uncomplicated umbilical hernia.