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.

Is surgery necessary?

According to the observations of pediatric surgeons, small umbilical hernias are prone to self-healing. In three-year-old children, the tissues of the umbilical ring gradually become stronger, losing their elasticity, and the defect closes. However, if the disease does not go away by the age of 5, then there is no chance of self-healing. In this case, surgical tactics involve planned surgical treatment.

The optimal age for umbilical hernia surgery is 5–7 years. At this age, the baby's tissues are pliable and quickly recover, forming a healthy umbilical ring. Adolescents may experience certain difficulties during surgery.

Emergency operations are carried out strictly according to indications. Surgeons will agree to operate on huge hernias that are prone to complications only after the baby reaches 6 months. The decision to undergo surgery is always made based on the doctor's opinion.

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.

Treatment at home

Small umbilical hernias (up to 3 cm) go away on their own when the child reaches three years of age. Doctors say that no active action is required to cure them. However, with large formations, for the purpose of prevention and to reassure parents, pediatricians give recommendations for conservative treatment.

It must be comprehensive, systematic and long-term. The plan of therapeutic measures is selected by the doctor. If the baby’s family members agree to strictly follow the doctor’s instructions, the treatment process begins.

Popular methods of dealing with umbilical hernia include:

Bandage (belt, corset)

The special bandage BG-101D and other children's models are used in combination and with the progression of pathology. You should not purchase the product yourself; it should be chosen by a doctor. The doctor explains to parents how to use the bandage correctly.

The bandage belt allows you to securely fix the hernial sac inside the abdominal cavity, equalizing internal and external pressure. It performs the following functions:

1. prevents internal organs from coming out;
2. has a weak compression effect in the umbilical area;
3. is a kind of corset for the muscles of the abdominal wall;
4. prevents hernia strangulation.

The device is used as an independent method of treatment, and in the pre- and postoperative period. Externally, the product looks like a wide belt with fastenings. It is made of hypoallergenic material.

However, if the baby experiences an allergic reaction when using it, the treatment is canceled.

You should not wear a bandage in case of complicated hernias or in the presence of skin diseases at the site of fixation.

The doctor decides how long to wear the bandage belt. The doctor must also correct the umbilical hernia before using the device for the first time. Parents can then do this. The scheme for putting on the bandage is as follows:

1. put the baby on his tummy for a few minutes to let the gas go away;
2. carefully examine the baby’s skin on the back and stomach, assess the condition of the hernia - the skin everywhere should be clean and dry;
3. lay the belt on a hard surface;
4. place the child on it with its back down;
5. carefully straighten the hernial contents and fasten the belt, making sure that the belt is located exactly in the navel area (one parent can help the other by holding the baby);
6. wear the device no more than 12–16 hours a day, removing it at night.

As a rule, after two months of wearing a bandage, small hernias successfully regress. This treatment method is optimal and safe in most cases.

Patch

You can buy an umbilical hernia patch at a regular pharmacy. The contraindications for it are the same as for the bandage. The doctor must direct the hernial contents into the abdominal cavity before the first gluing. He trains parents.

The patch can then be removed at home. However, if the sealing is done incorrectly, the risk of complications is very high, so it is still recommended to entrust the replacement procedure to a specialist.

In Soviet times, an ordinary adhesive plaster was used, which often caused unwanted local reactions.

Nowadays modern hypoallergenic products have appeared.

The most popular is the Porofix patch, which is made of waterproof material, which allows you to bathe your child without removing it. The navel must be sealed for 10 days, then replaced. The duration of the course is determined by the doctor. If any skin manifestations appear in the area where the product is applied, it must be immediately removed and treatment discontinued.

Taping

Kinesio taping has gained particular popularity recently. It is used to treat many diseases of the musculoskeletal system. However, pediatricians recommend refraining from gluing tapes to infants.

Scientific studies have not been conducted to confirm the safety and effectiveness of this method. Applying tapes to the umbilical area is dangerous.

Massage

Massage, like gymnastics, is, in principle, recommended for all infants. However, you need to massage a child with an umbilical hernia correctly, otherwise the effect may be negative. In order not to harm the baby, it is enough for the mother to learn how to perform simple actions by watching how a specialist does it.

First, perform circular stroking movements on the tummy (strictly clockwise, along the loops of the large intestine), then counter stroking, then pinching around the navel.

The massage is combined with placing the baby on his tummy and turning him on his side. This allows you to strengthen not only the rectus muscles, but also the oblique muscles of the anterior abdominal wall. Typically, massage procedures are done in the evening, after bathing, when the baby is as relaxed as possible.

Strengthening poses (laying on the stomach)

This is the simplest and most obvious way to strengthen your abdominal muscles. Each time before feeding the baby should be placed on the tummy. It should lie there for 10–15 minutes. Naturally, the hernial contents should be in the abdominal cavity.

Exercise therapy (gymnastics)

Young children should perform physical therapy under the supervision of professionals. An anti-hernia set of exercises is aimed at strengthening and improving blood circulation in the anterior abdominal wall. This includes:

• encouragement of turning over and twisting legs in the air;
• squatting with adult support;
• exercise on a fitball, etc.

The older the child, the more varied the activities will be. Exercise therapy is carried out only in fixing devices (bandage, regular plaster).

Copper nickel

Since ancient times, people have had a method of attaching a five-ruble coin to the navel (sometimes they use a ruble or a kopeck). Modern medicine has proven that this ancient method of treatment with copper is not only useless, but also dangerous. By resorting to such “treatment”, parents expose their baby to a huge risk of developing navel omphalitis (inflammation of the navel) and other serious consequences. Therefore, no manipulations with placing a nickel on the navel should be done.

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.

What is the danger of the disease

Like any other, an umbilical hernia can lead to emergency surgery. This situation, according to doctors, happens extremely rarely, but every parent must know what a strangulated hernia looks like and be able to recognize its signs.

How to determine infringement - the following symptoms will tell you, even at the initial stage of the process:

1. the hernia looks tense, full, motionlessly fixed in the umbilical ring, the skin over it is thinned, its color is changed;
2. upon palpation, the compaction is sharply painful and inactive;
3. the child will scream from severe abdominal pain, he may twist during a painful attack;
4. severe dyspeptic disorders appeared (vomiting, bloating due to non-excretion of gases, etc.);
5. body temperature has increased, there are signs of intoxication.

Important! In the event of a strangulated hernia, it is impossible to try to force the contents of the hernial sac into the abdominal cavity, since these actions will only aggravate the situation.

Any delay with such a clinical picture can become a tragedy. Indeed, when strangulated, the intestinal loops located in the hernial sac are clamped by the umbilical ring, and the required amount of blood stops flowing to them. The processes of tissue necrosis begin. Feces contribute to the rapid development of the inflammatory process. Perforation of the hernia is possible.

Tissue necrosis occurs rapidly. The extent of the surgical intervention performed and the prognosis depend on how soon a sick child is taken to the hospital. All dead tissue (parts of organs) will have to be cut out. If the operation is not performed in time, gangrene will begin.

To prevent an emergency, parents need to closely monitor the hernia. If it gradually increases in size, periodically does not straighten well, its release is accompanied by anxiety in the child, you should not wait for the disease to develop, you should urgently consult a doctor.

Alarming symptoms are constant constipation and failure to pass gas, the appearance of mucus and blood in the stool, systematic nausea and abdominal pain.

With improper care and non-compliance with hygiene measures, a hernia can be complicated by the development of an infectious process. Large formations often lead to chronic constipation (even coprostasis) and inflammatory bowel diseases.

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.

How is the operation performed?

Planned hernia repair is performed in a hospital under general anesthesia. The operation lasts 20–30 minutes. The surgeon reduces the hernial contents and sutures the hernial orifice; special meshes are not used in children.

There are several types of operations, which mainly differ in access, but their essence is the same. Previously, they used the same technique as in adults, according to Dyakonov - Mayo - Sapezhko. The Lexer method or the Spitz operation are possible. In the latter case, the postoperative suture will have a semi-oval shape.

Lexer method

Mayo method

Sapezhko method

Also, laparoscopy is now increasingly being performed, lasers and new minimally invasive, highly effective techniques are being used. The scar after such interventions is almost invisible (even if the hernia was large), and the patient can be discharged from the hospital earlier. However, such operations are performed for a fee.

Postoperative period

After the baby wakes up from anesthesia, but not earlier than 12 hours after the operation, he can be given water. The liquid should be drunk in small sips.

A day later, when intestinal motility appears, the child can be offered broth (or light soup), jelly, kefir, compote and baked apple. On days 2–3, the menu is expanded by adding porridge, fruit puree and yogurt. Over the next 24 hours, the baby is gradually fed his usual foods.

From the first day, if the child actively moves and sits up, a postoperative bandage should be worn on the stomach. The baby should not leave the bed for the first 24 hours.

In the next two days, a gentle hospital regime is observed, that is, jumping, sudden movements, etc. are excluded. The bandage is used for at least 2-3 weeks. You can walk and move freely at home in it.

After 3-4 weeks, the recovery will be over, and the child will be able to begin living as usual. However, in the future it is better to refrain from excessive physical activity, in particular from physical education. No special rehabilitation is required after standard hernia repair in children.