[Umbilical hernia in children].

INTRODUCTION: Umbilical hernia is a common condition in the pediatric population. EMBRYOLOGY: Umbilical hernia is a consequence of incomplete closure or weakness at the umbilical ring, where protrusion of intraabdominal contents may occur. ANATOMY: Fascia posterior to the canal is thinner, creating an area of weakness. Congenital or direct hernia occurs in this area, while herniation in the umbilical canal leads to indirect or acquired hernia. INCIDENCE: The incidence of umbilical hernia is 1.9% to 18.5% in white population. CLINICAL MANIFESTATIONS: The great majority of pediatric umbilical hernias are asymptomatic. Incarceration and strangulation are uncommon. Rupture of umbilical hernia with resultant evisceration is extremely rare. Umbilical hernia may also be the source of intermittent umbilical or abdominal pain. TREATMENT: Treatment options for umbilical hernias range from simple observation to surgical repair. The great majority close spontaneously and observation with periodic follow-up is appropriate in most cases. There are no available data to suggest that strapping improves or accelerates closure. Operation would be recommended for defects greater than 1 cm, by the age 3 to 4. Persistence or enlargement of fascial defect during the period of observation are reasons to consider repair, whatever the age. COMPLICATIONS: Complications of operative repair of umbilical hernias include those related to anesthesia and local wound infections.
CONCLUSION: Umbilical hernia is a common condition among infants and children. In the great majority of cases, the natural history is one of eventual closure without treatment. If spontaneous closure does not occur until the age of 3-4 years, operative correction is recommended.