Umbilical hernia in a child, symptoms, surgery and treatment in children.

Description of the disease

A hernia in a child’s navel is one of the most common surgical pathologies, which is more often observed in premature babies and underweight newborns, which is due to the immaturity of connective and muscle structures.

In itself, such a protrusion is completely harmless, although it frightens parents with its appearance. It does not cause pain, itching or other discomfort and in the vast majority of cases goes away on its own. The threat is posed by a condition called strangulation: it is compression of the hernial sac, which entails a disruption of the blood supply and the gradual death of surrounding tissues. Strangulation of an umbilical hernia in children is a direct indication for immediate surgical treatment.

Using an adhesive patch

This remedy can be used for newborns as soon as their umbilical wound has healed. The patch is glued so that a small fold is formed. The course of wearing the patch is 10 days. Typically, three courses are required with breaks in order to completely eliminate a hernia in an infant. The patch must be selected from a hypoallergenic material that allows air to pass through, so as not to irritate the baby’s sensitive skin. To ensure that the treatment of the disease is as effective as possible, it is recommended to combine the use of the patch with other methods. In this case, the result is more stable.

Classification

There are several classifications of the disease according to certain criteria. The main thing is to distinguish types based on origin. There are two types:

• congenital or embryonic defects that occur in a child even at the stage of intrauterine development, they are caused by disturbances in the formation of the abdominal wall;
• acquired or postnatal hernias that develop in infants during the first 1–4 months of life.

Additionally, direct and oblique hernias are distinguished depending on the direction of the protrusion, as well as reducible and irreducible.

Pathogenesis

The pathology begins to form in the fourth week of pregnancy, when the baby begins to develop a wall between the peritoneum and the pericardium. The development of the hernial sac, which accompanies the occurrence of a true congenital diaphragmatic hernia in newborns, occurs due to the connection of the pleural and abdominal layers. A false hernia is a condition when organs not covered by a sac penetrate into the chest through a through diaphragmatic opening. The severity of the child's health condition will be determined:

1. The volume of organs that have moved.
2. The presence of additional pathologies caused by a hernia.

Among the concomitant pathologies, heart defects, pulmonary hypoplasia, gastrointestinal diseases, kidney diseases and nervous system diseases are often identified. One of the most severe conditions is considered to be one in which a congenital diaphragmatic hernia in a newborn is combined with pulmonary failure.

Symptoms of an umbilical hernia in a child

First of all, the disease manifests itself externally in the form of a protrusion in the navel area, which is noticeable all the time or occurs when the baby coughs or cries. In a calm state, for example, when a child is sleeping, the hernia can almost completely “hide” in the abdominal cavity.

The size of the bulge varies from a few millimeters to 1–2 cm or more, and the larger the bulge, the more difficult it is to reduce under pressure. Additional signs of pathology may include:

• the appearance of brown spots in the navel area, which is caused by tissue scarring and the use of local antiseptics to treat the umbilical wound;
• an increase in the volume of protrusion when crying, the whims of the baby, during the period of ARVI, constipation, flatulence and colic;
• manifestation of a visible capillary network on a large hernia.

Children of preschool and school age may complain of discomfort and mild pain during physical activity, nausea, constipation and increased gas formation.

Rehabilitation after surgery

Recovery after surgery varies. Children recover the fastest after laparoscopy. Since this method is the most gentle of all, rehabilitation here takes 2-3 days maximum. Most often, babies are discharged within a day after such an operation.

Now we’ll tell you how a child feels after an umbilical hernia operation performed in other ways. If the surgical intervention was planned and timely, then the rehabilitation period takes no more than 14 days. This means that the child was operated on while still in preschool age. In this case, there should be no complications. The doctor will prescribe the wearing of a postoperative bandage, as well as the diet necessary for the little patient. You will not be able to eat foods that can cause gas in the intestines for some time. Physical activity will also need to be temporarily reduced.

The rehabilitation process takes the longest for those children who were urgently hospitalized. If the operation was unplanned, the hernia was strangulated or the hernia sac ruptured, then a longer recovery will be required. Usually, a course of medications and physical therapy are also prescribed.

Reasons for the development of the disease

Hernias form due to weak muscles in the anterior abdominal wall. The causes of a congenital hernia in a child can be:

• hereditary predisposition;
• intrauterine infection;
• congenital defects and developmental anomalies.

The causes of acquired umbilical hernia in children can be:

• gastrointestinal disorders (constipation, colic, flatulence);
• getting up and walking earlier;
• hacking cough;
• constant crying and screaming;
• prematurity;
• excess body weight;
• accumulation of fluid in the abdominal cavity;
• birth weight deficiency;
• rickets;
• heredity;
• malnutrition.

It has been proven that the pathology is more common in premature babies: every third child born prematurely experiences this disease.

Reasons for appearance and development

The disease is most often congenital in nature and is diagnosed immediately after childbirth - when screaming, the contents protrude greatly and it is impossible not to notice it. The occurrence is primarily affected by the slow healing of the hole due to a lack of collagen. Much less often, but still acquired injuries occur, the causes of which are:

• frequent crying;
• digestive problems causing regular diarrhea or constipation;
• obesity;
• hereditary factor - weakness of connective tissues can be transmitted from the older generation to the younger;
• postoperative consequences;
• bronchitis and other problems with the respiratory system, provoking a hysterical cough and, as a result, severe tension in the walls of the abdominal cavity.

As a preventative measure, normalization of stool, weight control, and elimination of factors that cause anxiety and tears are used.

Treatment of umbilical hernia in childhood

In general, the tactics of treating the disease can be divided into two areas: conservative techniques and surgical intervention.
A conservative approach is rational if the hernia is small in size, does not cause inconvenience and is not fraught with danger. Basically, a wait-and-see tactic is used: in most cases, umbilical hernias in young children go away on their own as they grow older. Additionally, the doctor may prescribe wearing a special bandage that minimizes the risks of pinching and further growth of the protrusion, massage, application of a patch and other auxiliary measures.

If the hernia has not healed in a child under 5 years of age, there are signs of strangulation, acute intestinal obstruction, or the size of the formation is alarming, surgical treatment is performed. It consists of repositioning the prolapsed internal structures into the abdominal cavity and suturing the hernial orifice. This operation is called hernioplasty and is carried out mainly as planned.

Which doctor deals with umbilical hernia?

A child with a hernia should be consulted with a pediatric surgeon. His task is to conduct an initial examination and make a qualified decision about whether surgery is needed in this case and, if necessary, when. The fact is that in almost 90% of cases the problem disappears with age on its own, without surgical intervention. Closing the umbilical ring is facilitated by infant massage and physical therapy. If the problem does not go away on its own, the operation is usually performed at the age of 5-6 years, before school.

It is almost impossible to miss an umbilical hernia, since in the first year of life the baby must visit a pediatric surgeon at least 2 times (at 1 month and at 12 months).

Is it necessary to operate on an umbilical hernia in a child?

During routine visits, the doctor performs a visual examination and palpation of the hernia. Each case has its own anatomical features, and the decision on surgical intervention should be made only by a competent pediatric surgeon! The size of the hernia and its structure are critical.

The main indication for hernioplasty in a baby is complications caused by an umbilical hernia: strangulation, tissue rupture. They are very rare. If the patient does not experience discomfort or pain in the abdominal area, he is less than 5 years old, and the bulge is small, then the likelihood of spontaneous closure of the ring remains, and the decision about surgery is postponed to a later date.

However, if the child has already turned 5, and it has not disappeared, most often surgery is still recommended. The same operation in a person over 14 years of age is more difficult.

Prevention

To prevent the intrauterine development of hernias, it is necessary to take planning and management of pregnancy seriously, regularly visit a doctor and undergo prescribed examinations.

The following measures will help avoid the formation of pathology:

• natural feeding of the baby or careful selection of formula;
• putting babies on their tummy every day;
• During breastfeeding, the mother follows a balanced diet without foods that increase gas formation (legumes, cabbage, flour confectionery);
• daily bathing and gymnastics.

It is undesirable to let babies cry and scream for a long time and hysterically: increased pressure on the abdominal wall can provoke divergence of the hernial orifice and further growth of pathology.

What not to do if parents identify signs of an umbilical hernia in a child:

• heat, cool, rub and knead the protrusion area;
• apply any ointments, creams, folk remedies to the navel;
• independently give children any medications without a doctor’s prescription;
• forcefully reduce the protrusion if it does not respond to light pressure.

At the first signs of infringement, which include discoloration of the skin in the navel area, vomiting, bloating against the background of the child’s crying, it is necessary to call emergency assistance as quickly as possible or take the child to the hospital yourself.

If you suspect the presence of an umbilical hernia in your baby, make an appointment with the surgeons of the SM-Doctor clinic. Our specialists will conduct a thorough diagnosis and prescribe effective and most gentle treatment in accordance with the indications.

Physiotherapy

Often, umbilical hernia in newborn children can be well cured with the help of therapeutic exercises. In our clinic, experienced specialists will select the necessary set of exercises for the child.

You can also do some exercises on your own at home. For example:

• before feeding the baby, place the baby on his tummy (for a couple of minutes);
• turn the child onto the left and right side alternately for a couple of seconds;
• turn the child to face you and, holding his head, tilt him back slightly;
• when the baby is lying on his back, carefully lift him by the arms, while supporting his back (the head and legs hang freely);
• Also, while lying on your back, carefully turn the baby onto his tummy;
• Place the baby on a bulky ball and roll it around, holding it by the legs.

Children under 8 years old can visit a trainer and do exercises with him. Such services are also available in our clinic.

Symptoms

If a baby develops a diaphragm defect in the womb, the risk of premature birth increases greatly. But if the hernia formation is small, the disease may not have symptoms. Children with this pathology often appear healthy in appearance, so you need to know what to look for. Namely:

1. The child cries quietly because the lungs cannot expand completely and breathing is difficult.
2. The child has cyanosis - a bluish color of the skin and mucous membranes.
3. Sometimes cyanosis develops due to asphyxia due to feeding.
4. Sometimes vomiting occurs.
5. Asphyxia may impair the functioning of the heart.
6. Breathing may be shallow and rapid.
7. No weight gain in the child for weeks.

Sometimes, among the symptoms of diaphragmatic hernia in newborns, one can observe a lack of appetite in the child, anemic manifestations, hemorrhages in the intestines, and sometimes pneumonia is added to the condition.

Causes

Today, doctors still do not agree on the factors that provoke a diaphragmatic hernia. But at the same time, among the reasons that can lead to the development of a child’s hernia are:

• severe pregnancy of a woman;
• frequent constipation during pregnancy;
• difficult childbirth;
• chronic lung diseases of pregnant women;
• excessive physical activity during pregnancy;
• some medications;
• bad habits.

This may lead to the need to find out what treatment should be for diaphragmatic hernia in newborns.

Perinatal diagnosis

It is carried out at the stage of an ultrasound scan of the expectant mother and is possible for another week after the birth of the baby. MRI may also be used. A characteristic sign of the disease is polyhydramnios in the woman in labor, which is caused by a bend in the child’s esophagus. Clinical recommendations for congenital diaphragmatic hernia in a newborn can begin to be given after it is revealed that some organs from the peritoneum are located in the chest. The disease may also be indicated by the absence of a gastric gas bubble in the peritoneum.

Making a diagnosis after the birth of a child

To determine the condition of a small patient, an x-ray is immediately prescribed. The doctor determines the presence of irregularly shaped lumps in the chest. The disease may be indicated by a displacement of the heart to the right, as well as the inability to distinguish the dome of the diaphragm. With the use of barium sulfate, it will be possible to draw conclusions regarding the location of the stomach and intestines and their displacement into the chest cavity.

Treatment

Methods of treatment and surgery for detecting diaphragmatic hernia in newborns are quite complex and are aimed at preserving the life of a small patient. Treatment can be carried out during pregnancy or after the birth of the baby.

Treatment during pregnancy

During pregnancy, pediatric surgery for diaphragmatic hernia includes fetoscopic correction of tracheal occlusion. A small hole is created in the tissue, allowing surgery to be performed. It makes sense to prescribe such an intervention at 26-28 weeks of pregnancy. A special balloon will be inserted into the fetal trachea to help the lungs form normally, and will be removed after birth.