What Is a Paraumbilical Hernia?

Abdominal hernias that occur in the umbilicus are collectively referred to as umbilical hernias. They can be divided into umbilical midline hernias and paraumbilical hernias according to the shape of the hernia, and can be divided into infant umbilical hernias and adult umbilical hernias according to the age of onset. Umbilical hernias in adults are usually acquired and acquired in most cases after middle age, with the exception of rare and persistent umbilical hernias in infants. They are more common in women (male to female ratio is 1: 3). Infant umbilical hernias are all umbilical hernias. Adult umbilical hernias are mainly paraumbilical hernias, and their incidence is much lower than that of infant umbilical hernias. Umbilical hernias in adults cannot heal by themselves, and are prone to incarceration or strangulation, which requires early surgical treatment.

Basic Information

English name: Umbilical Hernia
English alias
Visiting department: General Surgery
Multiple groups: Middle-aged woman

Common locations: Umbilical
Common causes: Increased intra-abdominal pressure and excessive stretching of the abdominal wall
Common symptoms: Pain and discomfort in the hernia sac, dull pain in the upper abdomen; incarceration manifested as local pain, abdominal cramps, vomiting, intestinal necrosis, intestinal perforation, etc. without timely operation

Causes of umbilical hernia in adults

Increased intra-abdominal pressure and excessive stretching of the abdominal wall are the main causes of umbilical hernia in adults. The umbilical foramen is the thinnest and most singular location of the abdominal wall. It is scar-like tissue formed by the umbilical cord falling off and the umbilical ring closed. Infantile umbilical hernias are basically congenital, mainly due to the umbilical ring not closing in time after birth. The majority of adult umbilical hernias are closed after the umbilical ring is closed. The closed umbilical ring and surrounding scar tissue are subject to continuous increase in intraabdominal pressure and excessive stretching of the abdominal wall. The umbilical foramen can not resist and form a local defect and gradually expand. Membrane and intestinal canal protrude to the surface through the defect, that is, an adult umbilical hernia is formed. The abdominal wall strength of women is lower than that of men. At the same time, pregnancy may lead to excessive stretch of the abdominal wall. Obese people have relatively high intra-abdominal pressure. Therefore, adult women have multiple pregnancy or the uterus is too large and obese when they become pregnant. The incidence of umbilical hernia is relatively high, and the age of onset is mostly between 35 and 50 years old. In addition, patients with a large amount of ascites in the decompensated stage of cirrhosis have persistently increased intra-abdominal pressure, and umbilical hernias are also very common.

Clinical manifestations of umbilical hernia in adults

There is a mass in the umbilical foramen, and the contents can be collected after lying in the early stage. However, the omentum prolapsed in the umbilical hernia is likely to form adhesion with the hernia sac hernia ring, so many patients will not completely disappear after a period of illness. . Some patients have symptoms such as pain and discomfort in the hernia sac or pain in the upper abdomen due to the omentum that is stuck to the hernia sac and even the bowel. Because the fascial ring surrounding the umbilical hernia ring of an adult is relatively strong and sharp, there are many opportunities for incarceration and strangulation of the umbilical hernia. Once incarceration occurs, intestinal obstruction symptoms such as local pain, abdominal cramps, and vomiting, Incarcers who do not do so in time will have intestinal necrosis, intestinal perforation, and acute peritonitis, which can eventually lead to death.

Adult umbilical hernia

Typical signs are mass changes in the umbilical foramen, which may disappear in early patients when they lie flat, but may appear when standing or exerting force; but those who cannot fully accept are more common than inguinal hernia. B-ultrasound and CT imaging examinations can be used as auxiliary diagnostic measures.

Adult umbilical hernia diagnosis

A simple and typical umbilical hernia can be diagnosed with a detailed history and careful physical examination. On physical examination, it can be seen that the mass is prolapsed near or in the middle of the umbilicus. The mass is often difficult or cannot be fully repaid, and there is an impact in the mass when coughing. Most of the contents of the hernia can be identified by palpation whether it is the omentum or the intestine. However, for atypical symptoms and obese patients, relevant imaging studies are needed to assist diagnosis, such as ultrasound and CT, which are of great help in determining the size and content of the defect.

Umbilical hernia treatment in adults

Once an adult umbilical hernia appears, if it is not treated, it will not only have no chance of self-healing, and it will continue to increase; even if it is recoverable at first, it will gradually become irrecoverable due to adhesion of the content, and even incarceration Even strangulation, adult umbilical hernia must be treated as soon as possible, and surgery is the only effective cure.

Non-surgical treatment is mainly applied to hernia bands, but hernia bands cannot cure adult umbilical hernias, and the application of hernia bands often causes skin abrasions, increases the adhesion inside and outside the hernia sac, and makes separation more difficult in future surgery. It can only be used when the umbilical hernia is small, no irreversible or incarcerated, and there are contraindications in surgery.

Surgical treatment is the most suitable treatment method for the majority of adult patients with umbilical hernia. Most of them are elective surgery. For patients who have incarcerated and strangulated, emergency surgery must be performed to cure. Smaller umbilical hernias can be sutured by local tissue, such as Mayo folding. Patients with larger umbilical hernias or patients with increased intra-abdominal pressure should be repaired with patches. Both open surgery and laparoscopic surgery can be used to repair the umbilical hernia. The surgical effect is more accurate than tissue repair, and the postoperative pain is less. For patients with cirrhotic ascites and factors with persistent intra-abdominal pressure increase, it is necessary to alleviate and control the factors of intra-abdominal pressure increase as much as possible before and after surgery. In the early open umbilical hernia surgery, the umbilical foramen were mostly removed. The current surgical method can basically preserve the umbilical foramen and will not adversely affect the appearance and psychology of patients.

Umbilical hernia prevention in adults

The prevention of umbilical hernia in adults is mainly to avoid and control various factors that lead to increased intra-abdominal pressure and excessive stretch of the abdominal wall for a long time, such as moderate abdominal exercise and weight loss, to avoid excessive stretch of the abdominal wall such as giant children and multiple uterus. Etc. For patients with liver cirrhosis and portal hypertension, they should be actively treated to control ascites.