• Bulge elicited by the Valsalva maneuver at the umbilicus
• Main complaint associated with umbilical hernias is the cosmetic appearance
• Patients may note discomfort or a heaviness sensation associated with the hernia bulge
• The hernia sac usually contains only pre-peritoneal fat although small bowel or other abdominal viscera may be present
• Classification of incisional hernias
–Reducible: Visceral contents of the hernia sac able to retract into the abdominal cavity
–Incarcerated: Visceral contents cannot be returned to the abdominal cavity
–Strangulated: Incarcerated hernia where the blood flow to the entrapped viscera is compromised
• Common in children (especially blacks), where spontaneous umbilical hernia closure by age 3 is the norm
• Develop not infrequently in cirrhotic patients with uncontrolled ascites
• Asymptomatic umbilical bulge most common presentation
• Patients may complain of a discomfort, fullness or heaviness associated with the hernia bulge
• Progressive enlargement of the defect is common
• Hernia bulge may or may not be reducible
• Incarcerated hernias are exquisitely painful to palpation
• Patients with a strangulated hernia may present with an acute abdomen
• Small bowel obstructive symptoms may be present with incarcerated umbilical hernias
• Plain films are typically normal
• US can be used to detect fascial defects as well as differentiate between an incarcerated umbilical hernia and a solid mass
• Abdominal pelvic CT scan is excellent in the detection of umbilical hernias and characterization of involved viscera; CT is particularly useful in diagnosing acute incarceration in the morbidly obese where physical exam is difficult and unreliable
• Thorough history and physical exam usually will accurately diagnosis umbilical hernia
• Abdominal CT scan when diagnosis is in doubt or to anatomically define the adjacent intestinal viscera in complicated cases
• Minimize or eliminate medications deleterious to wound healing such as corticosteroids
• Weight loss in obese patients
• Ascitic control in cirrhotic patients
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