UMBILICAL HERNIA

Umbilical hernia remains a common problem encountered by pediatricians and surgeons as one in every six to eight children will have an umbilical defect of some degree.  These defects are seen nine times more commonly in African-American than in Caucasian children.  Umbilical hernias are also more common in low birth weight infants.

 

Embryology-After the  midgut returns to the coelomic cavity during gestational week 10, the abdominal wall begins to close.  The lateral body wall folds medially narrowing the vitellointestinal isthmus to form the vitelline duct.  The body wall contracts round the vitelline duct to form the umbilicus.  The umbilicus contains attachments of the amnion, the yolk sac, the allantois and the umbilical vessels.

 

Closure of the fibrous ring in infants is independent of the surrounding rectus muscles.  The closure is reinforced by the obliterated umbilical arteries.  Most umbilical hernias occur through the umbilical vein portion of the ring.

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