Congenital Umbilical Hernia

00:01 Welcome.

00:02 The topic for this talk is congenital umbilical hernia.

00:06 In some other talks in GI pathology, we've been talking about gastroschisis, and omphalocele, those are rather larger defects in the abdominal wall.

00:17 All things considered, this is a relatively minor defect.

00:22 It occurs at the umbilicus.

00:25 And in fact, it is more of a full thickness weakness of the wall of the linea alba.

00:33 And it will lead to some degree of herniation of the midgut, but relatively minor.

00:38 In fact, if you've been looking at the slides having to do with omphalocele or gastroschisis, this is more just an exaggerated outie, if you want to think about it that way of the umbilicus.

00:51 So epidemiology.

00:53 It is present remarkably in about 15% of infants.

00:56 That tells you that this is not overall a major problem because it's so common.

01:02 In general, these will spontaneously close usually within the first two years of life.

01:08 They can be associated with other congenital disorders, such as hypothyroidism or Down syndrome, but don't necessarily have to be.

01:17 In terms of the pathophysiology, this is just a closure defect of the superficial abdominal wall.

01:25 So the normal umbilicus comes out between the 2 sheets of the rectus abdominal muscle.

01:31 At the linea alba, that dense connective tissue in the middle is the linea alba.

01:35 And usually, at the skin, there's a skin dimple.

01:39 If you have weakness of the linea alba of the connective tissue, then you can have a partial protrusion of the abdominal contents.

01:47 And so they go through this weak spot.

01:50 And evert the umbilicus an exaggerated outie.

01:55 The abdominal contents can bulge and completely press up.

02:00 But that's pretty much the extent of this, we don't have the same defects in the abdominal wall that we see with omphalocele or gastroschisis.

02:08 The clinical presentation is that when the baby is born, we know when they increase their intraabdominal pressure that means when they're crying, for example, you get a little protrusion.

02:20 And when the baby is relaxed or otherwise lying down, it goes back and it's completely flat.

02:25 And it can be completely reduced simply with pressure applied externally.

02:31 The diagnosis is one of a clinical diagnosis, "Oh, the baby is crying." "Oh, there's a little protrusion." The management is usually quite conservative, because this is not a major problem.

02:42 And as I've already said, the majority of these will close within the first few years of life.

02:48 So management is often conservative.

02:50 We watch in greater than 90% of cases.

02:53 If there's more of a protruding defect or if it doesn't close, that eventually will require surgery.

02:59 And with that, we've looked at an umbilical hernia.