Dataset Information

Spontaneous evisceration of infantile umbilical hernia.

ABSTRACT:

Introduction and importance

Infantile umbilical hernia is common in children. It has a regressive course in most cases. Conservative management is the standard in most cases before the age of 3 years unless there are complications such as incarceration, rupture with evisceration which are extremely rare and warrants emergency surgery.

Case presentation

Our case was a full term 6-month-old male of normal birth weight with history of umbilical hernia but with no obvious risk factors to develop complications. The loops evisceration was spontaneous with a small umbilical skin damage. The poor parental consultation on early surgical management and delayed presentation of the infant after evisceration could be the possible risks for ischemic changes and shock state at the time of presentation, however, prompt medical resuscitation and surgical management relatively improved postoperative outcomes.

Clinical discussion

Infantile umbilical hernia is considered one of the most encountered abnormalities of infancy. Most umbilical hernias are asymptomatic and discovered after birth. Complications of infantile umbilical hernia as incarceration or spontaneous evisceration are very rare but fatal. Certain factors increase the risk for developing spontaneous rupture of infantile umbilical hernia including the age of the infant or child, the defect size, umbilical sepsis or ulceration and any condition which raises intra-abdominal pressure, i.e., crying, coughing or positive ventilation.

Conclusion

Although infantile umbilical hernia is clinically benign condition with a regressive course in majority of cases, the risk of rupture of an umbilical hernia is exceedingly rare in pediatric population; physicians should be warranted with the possible risk factors for spontaneous rupture and in these patients expedite surgical repair.

SUBMITTER: Ali AK

PROVIDER: S-EPMC10236177 | biostudies-literature | 2023 Jun

REPOSITORIES: biostudies-literature

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Publications

Spontaneous evisceration of infantile umbilical hernia.

Ali Ahmed Kamel AK Elagan Moataz M Monib Fatma A FA Sabra Tarek Abdelazeem TA

International journal of surgery case reports 20230524

<h4>Introduction and importance</h4>Infantile umbilical hernia is common in children. It has a regressive course in most cases. Conservative management is the standard in most cases before the age of 3 years unless there are complications such as incarceration, rupture with evisceration which are extremely rare and warrants emergency surgery.<h4>Case presentation</h4>Our case was a full term 6-month-old male of normal birth weight with history of umbilical hernia but with no obvious risk factors ...[more]

PMID: 37247608

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Project description:ImportanceUmbilical hernia repair is one of the most commonly performed general surgical procedures. However, there is little consensus about the factors that lead to umbilical hernia recurrence.ObjectiveTo better understand the factors associated with long-term umbilical hernia recurrence.Design, setting, and participantsA retrospective cohort of 332 military veteran patients who underwent umbilical hernia repair was studied between January 1, 1998, and December 31, 2008, at the VA Boston Healthcare System. Recurrence and mortality outcomes were tracked from that period until June 1, 2014. Data were collected on patient characteristics, operative, and postoperative factors and univariate and multivariable analyses were used to assess which factors were significantly associated with umbilical hernia recurrence and mortality. All patients with primary umbilical hernia repair, with or without a concurrent unrelated procedure, were included in the study. Patients excluded were those who underwent umbilical hernia repair as a part of another major planned procedure with abdominal incisions. Data were collected from June 1, 2014, to November 1, 2015. Statistical analysis was performed from November 2, 2015, to April 1, 2016.Main outcomes and measuresThe primary study outcomes were umbilical hernia recurrence and death.ResultsOf the 332 patients in this study, 321 (96.7%) were male, mean age was 58.4 years, and mean (SD) time of follow-up was 8.5 (4.1) years. The hernia recurrence rate was 6.0% (n = 20) at a mean 3.1 years after index repair (median, 1.0-year; range, 0.33-13 years). The primary suture repair recurrence rate was 9.8% (16 of 163 patients), and the mesh repair recurrence rate was 2.4% (4 of 169 patients). On univariate analysis, ascites (P = .02), liver disease (P = .02), diabetes (P = .04), and primary suture (nonmesh) repairs (P = .04) were significantly associated with increased recurrence rates. Patients who had a history of hernias (125 [39%]) were less likely to have umbilical hernia recurrences (χ21 = 4.65, P = .03). On multivariable regression analysis, obesity and ascites were associated with significantly increased odds ratios of recurrence of 3.3 (95% CI, 1.0-10.1) and 8.0 (95% CI, 1.8-34.4), respectively. Mesh repair was seen to decrease recurrence with odds of 0.28 (95% CI, 0.08-0.95). There was no significant difference in complication rates between mesh repair and primary suture repair. The survival rate was 73% (n = 242) at the end of the study. Factors associated with mortality were older age, smoking, liver disease, ascites, emergency or semiurgent repair, and need for intraoperative bowel resection.Conclusions and relevanceAscites, liver disease, diabetes, obesity, and primary suture repair without mesh are associated with increased umbilical hernia recurrence rates. Elective umbilical hernia repair with mesh should be considered in patients with multiple comorbidities given that the use of mesh offers protection from recurrence without major morbidity.

Project description:IntroductionUmbilical hernia repair, despite its perceived simplicity, is associated with recurrence between 2.7 and 27%, in mesh repair and non mesh repair respectively. Many factors are recognized contributors to recurrence however multiple defects in the linea alba, known to occur in up to 30% of patients, appear to have been overlooked by surgeons.AimsThis systematic review assessed reporting of second or multiple linea alba defects in patients undergoing umbilical hernia repair to establish if these anatomical variations could contribute to recurrence along with other potential factors.MethodsA systematic review of all published English language articles was undertaken using databases PubMed, Embase, Web of Science and Cochrane Library from January 2014 to 2019. The search terms 'Umbilical hernia' AND 'repair' AND 'recurrence' were used across all databases. Analysis was specified in advance to avoid selection bias, was registered with PROSPERO (154173) and adhered to PRISMA statement.ResultsSix hundred and forty-six initial papers were refined to 10 following article review and grading. The presence of multiple linea alba defects as a contributor to recurrence was not reported in the literature. One paper mentioned the exclusion of six participants from their study due multiple defects. In all 11 factors were significantly associated with umbilical hernia recurrence. These included: large defect, primary closure without mesh, high BMI in 5/10 publications; smoking, diabetes mellitus, surgical site Infection (SSI) and concurrent hernia in 3/10. In addition, the type of mesh, advanced age, liver disease and non-closure of the defect were identified in individual papers.ConclusionThis study identified many factors already known to contribute to umbilical hernia recurrence in adults, but the existence of multiple defects in the linea, despite it prevalence, has evaded investigators. Surgeons need to be consider documentation of this potential confounder which may contribute to recurrence.

Dataset Information

Spontaneous evisceration of infantile umbilical hernia.

Introduction and importance

Case presentation

Clinical discussion

Conclusion

Publications

Spontaneous evisceration of infantile umbilical hernia.

Similar Datasets

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