/ treatment/pediatrics/ hernia – the kind of abdominal hernia which is characterized by protrusion of internals through umbilical a ring. Serve as displays of umbilical hernia the spherical camber in okolopupochny area arising at cough or crying, belly-ache, nausea. Diagnosis of umbilical hernia is carried out by the surgeon; at the same time additional tool methods - a X-ray analysis of a stomach, EGDS, a gerniografiya, ultrasonography of an abdominal cavity and hernial protrusion are used. At umbilical hernia at children up to 5 years LFK, massage of a belly wall, the general massage is carried out. At adults, and also in the absence of positive dynamics at children 5 years are more senior, as method of treatment serves surgical elimination of umbilical hernia.
Umbilical hernia – the most frequent surgical pathology in pediatrics which is diagnosed for 20% of the full-term and 30% of premature children. Among adults umbilical hernia meets at women more often 40 years are more senior, making 5-12% in structure of hernias of a forward belly wall. In operational gastroenterology understand the state which is followed by an exit of internals (a part of a gut and a big epiploon) through an expanded umbilical ring out of limits of a forward belly wall as umbilical hernia.
Reasons of umbilical hernia
In most cases umbilical hernia develops at early children's age. After falling away of an umbilical cord at newborns the umbilical ring is normal closed, the opening is obliterated by cicatricial and connecting fabric. In strengthening of area of an umbilical opening the important role belongs to belly muscles which in addition pull together a ring. Until processes of an obliteration of an umbilical ring are not finished yet, any increase in intra belly pressure can promote an exit of loops of intestines, a big epiploon and a peritoneum in okolopupochny space. Thus there is a formation of umbilical hernia.
As the main reason for developing of umbilical hernia serves hereditary weakness a fastion peritoneum. Presence at one of parents in the childhood of umbilical hernia increases risk of development of a similar disease in the child to 70%. Formation of umbilical hernia at children's age is promoted by crying of the child, persistent locks, gas generation in intestines, prematurity. Sometimes emergence of hernia coincides with the beginning of circulation of the child, especially when he too early accepts vertical position. Children with a congenital hypothyroidism, a Down syndrome, Harler's disease, laktazny insufficiency, an intestinal dysbiosis have tendency to formation of umbilical hernia. Contrary to ordinary opinion, formation of umbilical hernia is not connected with technology of processing of an umbilical cord in any way.
At adult age obesity, existence of postoperative hems, ascites, hoarse cough, hard physical work, stomach injuries can contribute to development of umbilical hernia. At women formation of umbilical hernia, as a rule, results during pregnancy from stretching of an umbilical ring, an atrophy of the fabrics surrounding it, decrease in resilience of a belly wall to increase in intra belly pressure.
Prevalence of umbilical hernias at women is explained by anatomo-physiological features - wider white line of a stomach, weakening of area of an umbilical ring in the course of pregnancy and childbirth. At adults umbilical hernia is often combined with flabbiness of a stomach, to diastases of direct muscles of a stomach.
Classification of umbilical hernias
In surgery umbilical hernias share on congenital and acquired. Embryonic umbilical hernias, germinal funic hernias (hernias of an umbilical kanatik) belong to congenital pathology. The acquired defects include umbilical hernias of children's age and umbilical hernias of adults.
At adults distinguish straight lines and slanting umbilical hernias. Formation of direct hernias is connected with thinning of a cross fastion adjacent to an umbilical ring. In this case the hernial bag leaves in hypodermic cellulose directly through an umbilical ring. At slanting umbilical hernias hernial protrusion is formed over or under an umbilical ring, passes through a crack between the white line of a stomach and a cross fastion (the umbilical channel), then comes out in hypodermic cellulose through an umbilical ring.
By criterion of a smeshchavemost umbilical hernias happen reducible and not reducible. Option of not reducible hernia is the restrained umbilical hernia.
Symptoms of umbilical hernia
Embryonic umbilical hernias usually meet at the heavy combined defects, incompatible with life. At this type of defect the underdevelopment of a forward belly wall through which there is a hernial bag containing internals (intestines, a liver) is actually observed. At embryonic umbilical hernias splitting of a breast, an underdevelopment of a pubic joint, defects of a diaphragm, a heart ektopiya, a bladder ektopiya often takes place. Death of the child, as a rule, steps on the 3rd knocks of life from peritonitis, pneumonia, sepsis; cases of a favorable outcome are single.
The acquired umbilical hernias proceed much more favorably. Umbilical hernia at the child more is cosmetic defect and is not followed by the developed symptomatology, is not inclined to infringement. Camber usually has the sizes from 1 to 5 cm in the diameter, becomes the most noticeable during the crying, cough, the child's natuzhivaniye. At rest or in a prone position umbilical hernia is almost imperceptible.
As early symptom of umbilical hernia serves emergence in the field of an umbilical ring of small spherical protrusion. At first this camber is absolutely painless and is easily set by pressing hernial protrusion. In process of formation of solderings between a forward belly wall and a hernial bag, protrusion becomes not set. Expressiveness of symptoms of umbilical hernia depends on its sizes, the size of hernial gate, existence of solderings etc. At narrow hernial gate loss of a hernial bag is followed by discomfort and abdominal pains, nausea, chronic locks.
Umbilical hernias can be complicated by infringement, an inflammation of elements of a hernial bag, koprostazy. Infringement of umbilical hernia is followed by the sudden sharp pain expressed by nausea, vomiting, emergence of blood in Calais, a delay of an otkhozhdeniye of gases and defecation, a hernia nevpravlyaemost in horizontal position, tension of hernial protrusion.
Diagnosis of umbilical hernia
Examination concerning umbilical hernia is conducted by the pediatrician or the surgeon. At survey of the patient existence of spherical protrusion in okolopupochny area pays attention. Sometimes in the field of hernia through the thinned skin contours of intestinal loops and a vermicular movement are noticeable. The palpation of an umbilical ring reveals defect of a belly wall, a hernial bag which the loop of a gut and a big epiploon, as a rule, enters. When crying the child, stomach tension hernial protrusion increases.
Carrying out endoscopic (EGDS) and x-ray research (a gerniografiya, a X-ray analysis of a stomach, a barium passage X-ray analysis on a small intestine) allows to gain an impression about contents of a hernial bag, to estimate passability of intestines and expressiveness of adhesive process. Necessary data are specified when performing ultrasonography of abdominal organs and hernial protrusion.
Treatment of umbilical hernia
At children umbilical hernia can spontaneously regress that is connected with physiological strengthening of muscles of a stomach. Therefore to 5-year age observation of umbilical hernia is shown. During this period the vykladyvaniye of children on a tummy is recommended, the toning massage of a forward belly wall, the general massage, LFK, imposing of a medical leykoplastyrny bandage is appointed to a navel.
To adults and children 5 years with not regressing umbilical hernia are more senior surgical treatment (gernioplastika) is shown. At umbilical hernia two types of operations – a gernioplastik by local fabrics and with use of mesh implants are applied.
At traditional plasticity the section in an infraumbilikalny (subumbilical) fold is made, the hernial bag is allocated and opened, its contents are set in an abdominal cavity, the peritoneum is taken in. Then the dublikatura of an aponeurosis in the cross or vertical direction is formed. At patients with obesity and an excess skin and fatty apron the abdominoplastika with transfer of a navel can be at the same time executed. Shortcomings of a gernioplastika of umbilical hernia local fabrics is need long (till 1 year) restrictions of physical activities and a high probability of a recurrence.
Gernioplastika with installation of a mesh artificial limb is deprived of shortcomings of the first operation. The mesh system in this case can be installed under skin over an aponeurosis (at big hernial gate) or under an aponeurosis under an umbilical ring. This type of operations reduces rehabilitation to 1 month, at the same time the number of a recurrence of umbilical hernia does not exceed 1%.
Forecast and prevention of umbilical hernia
An operation for umbilical hernia is undergone by children easily, as a rule, is not complicated by a recurrence and allows to achieve good cosmetic effect. In the absence of treatment umbilical hernia can accept – to become the complicated current option not set, to be restrained etc.
Serve as measures of prevention of umbilical hernia: the prevention of the situations connected with the baby's natuzhivaniye (hoarse shout and crying, an abdominal distension, locks and so forth), the rational feeding, preventive massage and gymnastics directed to strengthening of a belly wall, treatment of an intestinal dysbiosis, carrying a prenatal bandage by pregnant women.