Symptoms and features of the treatment of umbilical hernia in children

The navel is one of the weak points of the anterior abdominal wall. It is called weak due to the fact that fiber and muscles are completely absent here. an umbilical hernia often develops - a pathological protrusion of the abdominal organs through the umbilical ring.

An umbilical hernia in a child is a fairly common phenomenon, but in adults it occurs much less frequently.

Causes and factors for the development of umbilical hernia

What is an umbilical hernia and why does it occur in some children and bypass others?

An important role in the development of this disease is played by the usefulness of the development of the umbilical region. In the prenatal period, arteries, a vein and an urinary duct pass through the umbilical ring, connecting the mother and child, and normally, after birth and cutting the umbilical cord, the umbilical ring becomes empty and obliterated by connective tissue. But one child in 5 newborns over the next ten years, the risk of developing an umbilical hernia is quite high.

Causes of the disease:

1. Congenital defect of the anterior abdominal wall . In this case, the child is diagnosed with an omphalocele - a hernia of the umbilical cord. It is formed even in the fetal period, and can be diagnosed by ultrasound even in the fetus.
2. Incomplete overgrowth of the umbilical ring in newborns and children.
3. The birth of a child before the expected date, i.e. prematurity .
4. Reducing the stability of the obliterated umbilical ring and its atrophy due to increased intra-abdominal pressure.

The development of umbilical hernia in children is directly related to concomitant conditions that increase intra-abdominal pressure, and thereby increase the risk of pathological protrusion.

These states include:

• frequent crying of the child;
• problems with the gastrointestinal tract: colic, constipation;
• diseases accompanied by frequent and severe cough: bronchitis, pneumonia, whooping cough;
• phimosis is a disease of the penis, accompanied by straining when urinating.

Also, factors that increase the risk of umbilical hernia include:

1. Gender of the child: in boys, this type of hernia is much less common than in girls.
2. Diseases associated with genomic mutations, such as Down syndrome.
3. Protein-energy deficiency (congenital or acquired), in which there is a loss of body weight of the child and a decrease in the development of subcutaneous tissue, especially on the abdomen.
4. Decreased muscle tone, for example with rickets.
5. congenital hypothyroidism.

Symptoms

The main manifestation of a children's umbilical hernia is an oval or rounded protrusion in the umbilical region . It is compacted to the touch, sizes can reach up to 10 cm in diameter.

A feature of the disease is inconstancy: being in a horizontal position, in most children, the hernia is not detected or greatly reduced in size. It becomes noticeable either in an upright position, or with strong tension during crying, screaming, laughing, going to the toilet.

Can an umbilical hernia bother a child?

Most often, paraumbilical hernia in children is not accompanied by pain or discomfort. But doctors are aware of cases when pain in the abdomen and in the hernia area spoke of infringement or inflammation, which always requires more careful monitoring, additional diagnostic methods, such as ultrasound, and ultimately surgery.

It is impossible to unambiguously answer the question: does an umbilical hernia bother a child, because this disease occurs individually and in one it goes almost unnoticed, while in another it is accompanied by unpleasant sensations. If the child has one of the above symptoms, then this is an occasion to contact the pediatrician.

Methods for diagnosing umbilical hernia in children

An umbilical hernia can be diagnosed in children with an external examination and palpation. If a disease is suspected, the pediatrician writes out referrals for examination by a surgeon, who makes the final diagnosis. Usually, an examination is enough, but if complications are suspected, when the question arises of removing the hernia, additional examination methods are prescribed.

Additional diagnostics:

1. ultrasound . The study is carried out in order to determine the size of the protrusion, as well as to clarify which organ fell into the hernial sac. Also, with the help of ultrasound, an omphalocele can be diagnosed.
2. X-ray methods . Herniography is often used with the use of a contrast agent that accumulates in the hernial protrusion.

Since most hernias of childhood proceed without complications and rarely require surgical intervention, these methods are additional and clarifying.

Treatment

In the management of their young patients with an umbilical hernia, doctors tend to avoid surgery and do their best to eliminate the protrusion in other ways.

If the patient has no indications for surgery, then preference is given to the following methods and techniques of treatment:

1. exercise therapy . Exercises are aimed at strengthening the abdominal wall, for example, laying the child on the stomach 3 times a day before meals, raising the legs bent at the knees to the stomach in the prone position, raising the straight legs while lying, etc. For older children, more complex exercises are performed.
2. Massage . A massage therapist in a polyclinic teaches parents the correct massage technique and explains what to do so that over time it can be done at home on their own. The main movements are stroking the abdomen in different directions, pinching around the navel and light pressure.
3. Wearing a special fixing plaster . This method of treatment is used in children under 4 years of age. Strips of the patch bring together the skin in the navel. It is good to combine this method with massage or therapeutic exercises.

When parents suspect a hernia, what should not be done is to panic. In most cases, they go away on their own and, most importantly, they are not a dangerous disease in themselves. Of course, if you do not follow the above measures, then complications cannot be avoided. They pose a great threat to the child and require immediate surgical intervention.

Complications of a hernia that require surgery

Spontaneous disappearance of pathological protrusion in a child is not uncommon. Therefore, many doctors adhere to expectant tactics and do not resort to surgery. By the age of 2-3, most childhood umbilical hernias shrink and go away on their own.

Surgical intervention is advisable in the case of the following hernia complications, which are determined during ultrasound:

• gradual increase in hernial protrusion;
• uncontrollable hernia;
• infringement of the protrusion, which is characterized by the appearance of pain, nausea, vomiting, lack of defecation;
• infectious process with an inflammatory reaction of the umbilical region and the region of the hernial sac;
• mechanical damage to the hernia;
• development of intestinal obstruction and coprostasis.

These complications are direct indications for laparoscopy of an umbilical hernia.

Operation progress

The choice of method by which the hernia will be removed depends on its size and associated pathological conditions. This may be an open approach with dissection of the hernial sac, or it may be a laparoscopic operation, the least traumatic with a shorter rehabilitation.

Surgery is performed on younger children under general anesthesia, and on older children under local anesthesia. The duration of the operation is usually no more than an hour. The task of the surgeon is to set the contents of the hernial sac into the abdominal cavity, remove it and strengthen the weak spot to prevent recurrence. In children, loops of the small intestine and the greater omentum most often protrude.

With open access, the operation is performed according to the Lexer using a longitudinal incision or according to Spitz with a semicircular incision. After the protrusion is exposed, its wall, consisting of the peritoneum, is opened, and the organs that are inside are set. The hernial sac is excised and sutured. The skin is sutured and bandaged.

With laparoscopy, the same actions are performed only after the operation, three small scars remain on the body, in contrast to open access. For hernioplasty - strengthening a weak spot, either their own tissues or special meshes made of artificial materials are used.

This is done as follows:

• according to the Mayo-Sapezhko method, the edges of the aponeurosis of the umbilical ring are sutured;
• when using mesh implants, they are installed above or below the umbilical ring, the implant does not interfere with the child, and due to the material from which it is made, the mesh does not cause a rejection reaction.

Currently, surgeons prefer the method of strengthening the umbilical ring with mesh, as it is a more reliable way to prevent hernia recurrence, and it has a shorter recovery period.

Umbilical hernia in children: how to avoid?

If a child has at least one risk factor for developing an umbilical hernia, for example, a child suffers from colic and often cries, then some rules should be followed to prevent it.

How to prevent pathology:

1. Daily exercise aimed at strengthening the muscles of the anterior abdominal wall.
2. Massotherapy.
3. Treatment of diseases that can cause increased intra-abdominal pressure.
4. If a child on breastfeeding has digestive disorders, the mother's diet should be reviewed. With artificial feeding - change the mixture.
5. Monitor the weight of the baby, as its sharp increase can provoke the development of a hernia.

Knowing how dangerous an umbilical hernia is in children, you should not postpone your visit to the doctor even with the slightest suspicion of a disease. Only after his recommendations can you start massage courses and therapeutic exercises, both as a treatment and as a preventive measure. And do not be afraid if the surgeon prescribes an operation to remove a hernia - today this is one of the most frequently performed operations.