Umbilical hernia in children

Umbilical hernia is diagnosed by history and physical exam alone. No other tests are necessary prior to initiating treatment.

History and physical exam

Characteristic features include a bulge at the umbilicus, which has been present since birth. The condition is generally asymptomatic, although it may cause mild discomfort in some children. Examination typically reveals an easily reduced hernia sac with a well-defined rim of fascia and central defect of variable diameter. The overlying skin may appear stretched and proboscoid (redundant and protuberant). Discomfort or a tender umbilical mass in an individual with an unrepaired umbilical hernia is concerning for incarceration, with or without strangulation. Symptoms of bowel obstruction include vomiting, abdominal pain, and constipation.

Imaging

Umbilical hernia may be found incidentally on imaging obtained for unrelated reasons (computed tomography, magnetic resonance imaging). However, these tests are unnecessary for the diagnosis of the typical umbilical hernia.

In the case of a suspected strangulated hernia, clinical grounds alone are sufficient to make the diagnosis and no imaging is required.