Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • 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 +++ Epidemiology + • 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 +++ Surgery + • Repair can be performed laparoscopically or open +++ Indications + • Umbilical hernias should be fixed in all patients without medical contraindications +++ Contraindications + • Cirrhotic patients with uncontrolled ascites +++ Treatment Monitoring + • Clinical evidence of recurrence +++ Complications + • Postoperative wound or mesh infection• Recurrence +++ References ++Arroyo A et al: Randomized clinical trial ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth