Umbilical Hernia

The parents of a 3-month-old infant sought medical advice because of a mass in the child's umbilical area. The mass increased in size when the infant cried, coughed, or strained and was reducible inside the abdomen by external pressure.

This is an umbilical hernia; it results from imperfect closure or weakness of the umbilical ring. Clinically, an umbilical hernia presents as a soft, skin-covered swelling that protrudes through the fibrous ring at the umbilicus. The umbilical bulge becomes more apparent during episodes of crying, coughing, or straining and is easily reducible. The content usually consists of a piece of small intestine and sometimes omentum. The condition is most common among premature, female, Chinese, and black infants.

Most umbilical hernias resolve spontaneously within the first year. Infrequently, surgery may be necessary if the hernia becomes incarcerated or strangulated, increases in size after the first year of life, or persists for 4 or 5 years.