Incarcerated umbilical hernia in children: Not too rare

Umbilical hernia is a common condition in infants and children. The true incidence is unknown because many umbilical hernias resolve spontaneously. Historically, incarceration is considered rare (1-2); however, it seems to occur more frequently than it is generally believed. Most of the literature related to incarceration comes from African countries, where the black community predominates, and umbilical hernias are up to 10 times more common than in whites. It seems that the trend is increasing as well inFrance andEngland, where most of the population is white. We also observed the same tendency inIran.
a retrospective analysis was performed of the hernias at our institution over an eight month period. The patients presented at our institution over a period of eight months, from March 21st to October 20th 2006.
15 children with umbilical hernias were seen in the hospital over the period. 4 patients had incarceration (26%). There were 3 girls (75%) and 1 boy (25%). Three infants and one teenager. Mean age of the infants: 13 months. The teenager was 18 years old and was affected of cirrhosis without ascites. Incarceration occurred in hernias of more than 1.5 cm in diameter. Two patients underwent manual reduction and the hernia was repaired the following morning, after proving the absence of peritoneal signs. The other two patients were operated the same day the symptoms began, as the hernia was irreducible. All patients underwent repair of the umbilical hernia using standard methods. We did not need to perform intestinal resection in any of our patients; however omental resection was done in one of them. All patients had an uneventful post-operative course and there was no mortality.
Conclusion; incarcerated umbilical hernia is not as uncommon as thought. Therefore, a more active therapeutic approach is recommended even in smaller hernias, from more then an aesthetic point of view.