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Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
Paediatric umbilical hernias typically close by the age of 4–5 without intervention; however, although complications are rare they must be recognised and acted on immediately. The umbilicus transmits the contents of the umbilical cord via a defect in the linea alba. The umbilical ring usually closes by contraction, the umbilical vein fibroses to become the round ligament of the liver, and attaches to the umbilicus. This provides anchorage to the umbilicus and protects against the formation of a hernia, however, a minority of patients are susceptible to hernia formation if this process does not occur correctly. Important risk factors for umbilical hernia formation include: Low birth weightAfrican ancestryTrisomy 13, 18 and 21Congenital hypothyroidismHurler's syndromeBeckwith-Wiedemann syndrome
Inguinal hernia, hydrocele, and other hernias of the abdominal wall
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Sophia Abdulhai, Todd A. Ponsky
An umbilical hernia is very common in infants and young children. The hernial sac protrudes through a defect in the umbilical ring due to a failure of complete obliteration at the site where the fetal umbilical vessels (umbilical vein and the two umbilical arteries) enter the abdominal wall.
General Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rebecca Fish, Aisling Hogan, Aoife Lowery, Frank McDermott, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Yew-Wei Tan, Thomas Tsang
A 6-month-old male infant presents with a painless swelling in the umbilical region, which increases in size when he cries and disappears when he is asleep. What is the most likely diagnosis, and what is the natural history of this condition?This is most likely an umbilical hernia.This is a common surgical problem of newborn infants and is present in 10% of Caucasian babies.The umbilical ring closes over a period of time after birth, and the fascia of the umbilical defect strengthens.Most (95%) will spontaneously resolve by 3 years of age.
Systematic review and meta-analysis of the inter-recti distance on ultrasound measurement in nulliparas
Published in Journal of Plastic Surgery and Hand Surgery, 2023
The average value of the inter-recti distance is of great significance in the diagnosis of RAD Ultrasound may be considered the gold standard for the clinical measurement of the inter-recti distance with a low standard error of measurement. There was no significant difference between the values obtained by ultrasound and those measured during surgery at the supra-umbilical levels and umbilicus levels [19,20]. Two issues should be clarified for the measurement of the inter-recti distance by ultrasound: The first is regarding measurement location. The inter-recti distance is not equidistant from the pubic symphysis to the inferior xiphoid process. In the studies included in this review, the measurement location of the inter-recti distance by ultrasound is diverse, with the umbilical upper margin of the umbilical ring and 2.5 cm above the umbilical ring being the most frequently measured locations. When pooled the data, grouped the measurement locations into three areas, namely the umbilical, epigastric, and infraumbilical areas. We did not use the data of studies measuring the distance at the xiphoid process (Beer [6]), as RAD has little effect on the inter-recti distance at the xiphoid process, and the distance was due to anatomical variation. The results indicated that the inter-recti distance of healthy nulliparous women as measured by ultrasound did not exceed 10 mm in all three areas, and the inter-recti distance in the umbilical region was the widest. The inter-recti distance was significantly smaller at the infraumbilical area than the umbilical and the epigastric areas (4.09 mm vs. 8.77 and 7.22 mm, respectively).
Laparoscopy-Assisted Versus Open Surgery in Treating Intestinal Atresia: Single Center Experience
Published in Journal of Investigative Surgery, 2021
Mario Lima, Neil Di Salvo, Chiara Cordola, Simone D’Antonio, Michele Libri, Michela Maffi, Tommaso Gargano, Giovanni Ruggeri, Vincenzo Davide Catania
Pneumoperitoneum is created with 6–7 mmHg of pressure and 0.5–1 L/min of flow of Carbon dioxide. The abdominal cavity is carefully explored until the identification of the steno-atresic segment is identified. The pathological tract is then exteriorized through the umbilical incision. Considering the elasticity of the neonatal umbilical ring, the skin and subcutaneous tissue around the umbilical trocar site can be easily expanded (without widening the incision) to bring out both ileal atretic ends through the umbilical incision (Figure 2). The whole intestine is then exteriorized and irrigated with water. The entire distal small bowel is then investigated to exclude any other malformation in the distal bowel. This procedure can also be performed laparoscopically to avoid bowel loops manipulation. The proximal atresic/stenotic bowel end should then be resected or tapered, as required, leaving the bowel opening the same size as the distal bowel to facilitate an end-to-end primary anastomosis (Figure 3). The laparoscope is reintroduced to confirm no kinking or torsion of the anastomosis and no drains are left in place. A temporary ileostomy is performed in instances of perforation, or if there is a question of bowel viability.
Umbilical Cord Diameter at the Junction of the Body Wall in the Newborn. Is It a Biomarker for Congenital Umbilical Hernia?
Published in Fetal and Pediatric Pathology, 2018
The intestines are physiologically herniated towards the proximal part of the umbilical cord in the early fetal period. That is called extracoelomic cavity (5,6). The intestines migrate back to abdominal cavity in the 10–12th weeks gestation, the umbilical ring usually closes and the extracoelomic cavity disappears. The Wharton's jelly and the umbilical vessels form the resultant umbilical cord. On occasion, the umbilical ring does not close and intestines may remain in the extracoelomic cavity. This process is called congenital hernia of the umbilical cord (CHUC) in the postnatal period (5–9), which is estimated to occur once in 5000, with a male preponderance (3:1), and is associated with prematurity (10). In CHUC, cord clamping may cause intestinal obstruction, in that often ileum is contained within the sac (11). For this reason, the immediate evaluation of the diameter of the umbilical cord immediately after birth may have a predictive value for the diagnosis of CHUC.