History and exam

Key diagnostic factors

common

presence of risk factors

Key risk factors include low birth weight (<1500 g) and African/African-American ancestry.

present since birth

Recognised after the umbilical cord sloughs and the skin heals.

bulge at the umbilicus

Parents may notice this feature. Abdominal examination reveals a bulge at the umbilicus, with intact overlying skin.

change in size/tension during movement

Becomes larger or tense when the infant cries or strains.

skin changes

The skin may become stretched and appear proboscoid (redundant and protuberant).

easily reducible hernial sac

Digital examination reveals an easily reducible hernial sac and a well-defined rim of fascia with central defect. Defect diameter varies from a few millimetres to a few centimetres.

well-defined rim of fascia with central defect

Digital examination reveals an easily reducible hernial sac and a well-defined rim of fascia with central defect. Defect diameter varies from a few millimetres to a few centimetres.

variable diameter of defect

Digital examination reveals an easily reducible hernial sac and a well-defined rim of fascia with central defect. Defect diameter varies from a few millimetres to a few centimetres.

uncommon

symptoms of small bowel obstruction

Incarceration may occur rarely; usually involving the small bowel; results in obstructive symptoms such as vomiting, abdominal pain, and constipation. Identification of these features is critical as surgery may need to be expedited.

Other diagnostic factors

uncommon

intermittent discomfort

Generally asymptomatic. Older children occasionally report intermittent discomfort.

Risk factors

strong

low birth weight

Umbilical hernia is noted in up to 75% of infants weighing <1500 g.[1] The rate of umbilical hernia is increased by up to 30% in premature, low birthweight infants (<1000 g).[2]

African ancestry

Some studies document a high incidence in African infants.[2]​​[3]

weak

Beckwith-Wiedemann syndrome (BWS)

Children with BWS often present with abdominal wall defects, pre- and post-natal overgrowth, and macroglossia.[7]

trisomy 21, 18, 13

Umbilical hernias are associated with chromosomal disorders including Down's syndrome.[7]

congenital hypothyroidism

Like other congenital disorders, the risk of umbilical hernia is elevated in this condition.[7]

mucopolysaccharidoses

Umbilical hernias are found in the familial lysosomal storage disease, Hurler's syndrome.[8]

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