Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android

  • • 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

Symptoms and Signs

  • • 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

Imaging Findings

  • • 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

  • • Epigastric hernia

    • Urachal cyst

    • Primary or metastatic abdominal wall neoplasm

Rule Out

  • • Incarcerated or strangulated hernia

    • Abdominal wall tumor

  • • 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

When to Admit

  • • Depends on magnitude of repair and comorbidities; patients may require postoperative hospitalization

  • • Minimize or eliminate medications deleterious to wound healing such as corticosteroids

    • Weight loss in obese patients

    • Ascitic control in cirrhotic patients


  • • Repair can be performed laparoscopically or open


  • • Umbilical hernias should be fixed in all patients without medical contraindications


  • • Cirrhotic patients with uncontrolled ascites

Treatment Monitoring

  • • Clinical evidence of recurrence


  • • Postoperative wound or mesh infection

    • Recurrence


Arroyo A et al: Randomized clinical trial ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.