Kingdom of Saudi Arabia, King Abdulaziz university, Jeddah

Hernia Of The Umbilical Cord

Dr. Mazen O. Kurdi (FRCSI)
Ass. Prof. pediatric surgery
Prof. Dr. Yasir S. Jamal (FRCSI, FICS)
Prof.
f off pediatric
d
& plastic
l
surgery
President, Saudi association of ped. Surgery
Vice-president,
d
Saudi
d scientific
f ass. off plastic
l
surgery
Head, division of pediatric surgery

Umbilical cord hernia

Introduction:
It is a simple failure of complete
return of the midgut to the peritoneal
cavity which usually occurs around
th 10 week.
the
k

Umbilical cord herniacont

It is uncommon .
Small defect (less than 2 cm) .
Located at the umbilicus with the
umbilical cord extending from it.
it
Covered with a sac.
Contains only the midgut .

Umbilical cord herniacont

These
ese pat
patients
e ts might
g t have
a e
malrotation , although it is not
usually
ll a cause off intestinal
i
i l
obstruction.
obstruction

( Michael D.Klein / Grosfeld etal. pediatric surgery sixith edition 1157-1171,2006)

Umbilical cord herniacont

W t umbilical
Wet
bili l
cord

clamp.
l
& sep.
cord

D
Dryness

Normal Umbilical Cord

Normal Umbilical Cord

How to differentiate?

Cogenital Abdominal wall defects

Defect

site

sac

contents

frequency

Associated
anomalies

outcome

Omphlocele
(lat. Fold)

umbilicus

yes

Liver ,
intestine
,spleen,
gonad

common

Chromo. &
cardiac

Good (dep.
on the
associated
anomaly)

Omphlocele
(cephalic
Fold)

Sup.
umbilicus

yes

Liver,
intestine

rare

Cardiac,stern
al cleft
,central
t d diph.
tendon
di h

poor

Omphlocele
(caudal Fold)

Inf. umbilicus

yes

intestine

rare

Bladder
extophy,impe
rforated
anus&episp

fair

Umbilical
cord hernia

umbilicus

yes

intestine

unusual

uncommon

good

Gastoschisis

Rt. umbilicus

No

intestine

common

Intestinal
atresia

good

Ectopia
cordis
thoracis

Midline
sternum

No

heart

rare

cardiac

poor

Umbilical cord herniacont

Management:

Counseling and reassuring the parents

Careful examination to determine the

following:
9 Diameter(<2cm)
Diameter( 2cm)
9 Status of the content

Reducible
Irreducible which might be due to adhesions
or membrane.

Umbilical cord herniacont

The
h type off management depends
d
d upon:

If the base is narrow & there is short protrusion

off the
h contents
Reduction
d i off the
h contents
& Simple ligation of the sac .

Umbilical cord herniacont

If the base is Broad & there is long

epithelialized protrusion around the umbilicus
Initial reduction , clamping & immediate or later
repair
p with cosmetic umbilicoplasty
p
y

Umbilical cord herniacont

If the contents are not reducible or if there

i bleeding
is
bl di
Mandatory
M d
surgical
i l
intervention .

Umbilical cord herniacont

The contents are easily reduced by
holding the sac upwards & gently
g the bowel into the peritoneal
p
milking
cavity.
The fascia can always be closed
primarily & a cosmetic umbilicoplasty
is nea
nearly
l always
al a s feasible which
hich might
be immediate or late (OR).

Umbilical cord herniacont

Different presentations:

Umbilical cord herniacont

Care should be taken as the content of

the sac is the midgut with or without
9 Appendix.
Appendix
9 Patent omphalomesenteric duct.
9 Adhesions between the bowel and
the sac as it will be seen in one of our
cases.

(Catrena Borgna - pignatti etal. Journal of pediatric surgery,30:1717-1718,Des.1995)

(David M. sherer .Gynecol obstet Invest 51:66-68,2001)

Umbilical cord herniacont

The umbilical abnormality can be

di
diagnosed
d with
i h certainty
i
after
f
delivery
d li
,
but ,antenatal ultasonography , can be
h l f l in determining
helpful
d
these
h
abnormalities such as
Hernia of the umbilical cord
Omphalocele
Teratoma of the cord.

Umbilical cord herniacont

This gives a indication for

distal clamping of the cord to
avoid injury of the bowel
until
til the
th b
baby
b is
i attended
tt d d by
b
the pediatric surgeon
surgeon.

Umbilical cord herniacont

In KAUH 14 cases of umbilical cord

hernia seen & treated over the last 10
yyears ((1997-2007).
)
Retrospective review of antenatal
ultrasonography did not indicate the
presence of the abnormality.
All of the cases were near term ranging
between 34-38 weeks.

Umbilical cord herniacont

12 of which had reducible content

while the other 2 cases presented by
irreducibility due to adhesions in one
of them and septum that prevent
the reduction in the other one which
led to hemorrhagic fluid upon trial of
the reduction.

Umbilical cord herniacont

8 of the cases were managed by a simple

reduction
d ti off th
the contents
t t and
d liligation
ti off
the sac. (short neck ,narrow base)

Umbilical cord herniacont

4 off the
h cases had
h d wide
id base
b
&
long epithelialzed protrusion , were
managed by repair of the umbilical
hernia ( mayo s repair & cosmetic
umbilicoplasty )
2 immediate
i
di
.
2 late closure.

Umbilical cord herniacont

2 cases needed immediate surgical intervention

in the form of Repair & umbilicoplasty due to
irreducibility which was due to:

Adhesions.
Adhesions
The presence of septum.

Umbilical cord herniacont

Despite
p of that most of the patients
p
with hernia of the umbilical cord
were having malrotation,
malrotation but , this
was not an indication to explore
any of our patients.

( Grosfeld etal. pediatric surgery sixith edition 1157-1171,2006)

Umbilical cord herniacont

Conclusion:

Hernia of the umbilical cord is a rare

entityy of the abdominal wall defects ,
but , careful attention should be paid
in order not to miss it.
If there is any suspicion of an umbilical
p should
cord hernia , the umbilical clamp
be applied distally to avoid injury of the
contents.

Umbilical cord herniacont

Force should not be applied

pp
in
order not to cause any damage
to the bowel while reducing the
contents, keeping in mind the
possible causes of irreducibility.

suggest the presense of an umbilical mass ,

but other diffrentials can not be excluded
but,
which might be an omphalocele , umbilical
hernia with associated omphalomesenteric
duct (David M. sherer .Gynecol obstet Invest
51:66-68,2001)
51:66
68,2001) or an isolated patent
omphalomesenteric duct (Jona JZ:congenital
hernia of the cord and associated patent
omphalomesenteric duct :a frequent neonatal
problem ? Am J perinatol 1996;13:223-226.)

Umbilical cord herniacont

Differentiation from other abdominal wall

defect
f
should be kept in mind
umbilical hernia--- the defect is covered by a
normal skin and is rarely present at birth ,
instead usually becoming apparent in the first
weeks or months of life after the cord
separation & epithelialization of the umbilical
stump.

Umbilical cord herniacont

4 of the cases had wide base &

long epithelialzed protrusion , were
managed by repair of the
umbilical hernia ( mayo s repair &
cosmetic umbilicoplasty )

2 immediate .
2 late closure.

Umbilical cord herniacont

If the base is narrow

& there is short
protrusion ---------Reduction
d
off the
h
contents & Simple
l
ligation
off the
h sac .

Umbilical cord herniacont

If the base is Broad

& there is long
epithelialized
protrusion -----Initial reduction ,
clamping
l
&
immediate or later
repair with
h cosmetic
umbilicoplasty