Omphalocele: what it is, diagnosis and treatment of umbilical hernia. Reasons for the development of omphalocele in a newborn Various methods of treating hernias

Hernia of the umbilical cord, or umbilical hernia(omphalocele), is a developmental defect in which by the time the child is born, part of the organs abdominal cavity located outside the peritoneum - in the umbilical membranes, consisting of amnion, Wharton's jelly and primary primitive peritoneum (Fig. 149). Occurs in 1 in 5000-6000 newborns.

Rice. 149. Hernia of the umbilical cord (diagram).

The origin of the hernia is associated with a violation of the development of embryogenesis in the first weeks of intrauterine life. At this time, the abdominal cavity cannot accommodate the rapidly increasing intestinal loops. Located extraperitoneally, in the umbilical cord membranes, they go through a temporary stage of “physiological embryonic hernia”, and then, after completing the process of rotation, they return to the expanding abdominal cavity. If, as a result of a violation of the process of intestinal rotation, underdevelopment of the abdominal cavity or a violation of the closure of the anterior abdominal wall Some organs remain in the umbilical cord membranes, and the child is born with a hernia of the umbilical cord.

Depending on the time of stopping the development of the anterior abdominal wall, two main types of umbilical hernias are distinguished - embryonic and fetal. In embryonic hernias, the liver does not have a Glissonian capsule and fuses with the membranes of the umbilical cord, which plays an important role during surgical intervention.

By clinical signs umbilical cord hernias are divided into in the following way:

by hernia size: small - up to 5 cm, medium - up to 10 cm, large - more than 10 cm;
according to the condition of the hernial membranes: uncomplicated (with unchanged membranes), complicated (rupture of membranes, purulent melting, intestinal fistulas).

Approximately 65% of children with umbilical cord hernias have associated developmental defects (heart, gastrointestinal tract, genitourinary system).

Clinical picture. When examining the child, it is discovered that part of the abdominal organs is located in the umbilical cord membranes. The hernial protrusion is located in the projection of the navel, above the defect of the anterior abdominal wall. The umbilical cord extends from the upper pole of the hernial protrusion. If developmental arrest occurs early, then a significant part of the liver is located outside the abdominal cavity and most of intestines. In cases of later developmental delay, only part of the intestinal loops remains extraperitoneal. In practice, the contents of an embryonic hernia can be all organs except the rectum. With a defect in the diaphragm, ectopia of the heart is observed.

In the first hours after birth, the puovine membranes that form hernial sac, shiny, transparent, whitish. However, by the end of the first day they dry out, become cloudy, then become infected and covered with fibrinous deposits. If measures are not taken to prevent and treat infected membranes, peritonitis and sepsis may develop. When the membranes become thinner and rupture, eventration occurs.

Rice. 150. Treatment of umbilical cord hernia (diagram). A - radical surgery with layer-by-layer suturing of the abdominal wall tissues; b - Gross operation (suturing the skin over the unopened hernia membranes); c - alloplastic method; d - conservative treatment.

Treatment . Children with umbilical cord hernias begin to be treated immediately after diagnosis. Two treatment methods are used: surgical and conservative (Fig. 150).

Absolute contraindications To operative method treatments are congenital heart disease, severe prematurity and severe birth traumatic brain injury. For these children, conservative treatment is used, which consists of daily treatment of the umbilical cord membranes with 2% tincture of iodine and alcohol. After the coagulation crusts have separated and granulations have appeared, they switch to ointment dressings (Vishnevsky ointment, Shostakovsky balm). Antibiotics and physical therapy are prescribed ( ultraviolet irradiation, electrophoresis with antibiotics), restorative and stimulating therapy. The hernial sac is slowly covered with epithelium and, shrinking, becomes smaller. Complete epithelization is observed after 2-3 months.

A relative contraindication to surgery is large hernias with a clear discrepancy between them and the volume of the abdominal cavity, since simultaneous reduction internal organs into the underdeveloped abdominal cavity leads to a sharp increase in intra-abdominal pressure, limited mobility of the diaphragm and the development of a sharp respiratory failure, which often causes fatal outcome.

However, in these children, if they were born full-term and without severe concomitant malformations and diseases, a two-stage Gross operation or closing the defect with alloplastic material can be successfully used. According to the method proposed by Gross, only the excess part of the umbilical cord is excised. The membranes are treated with 5% tincture of iodine, the skin is widely mobilized to the sides. The selected edge of the muscular aponeurotic defect is sutured to the membranes of the hernial sac as close as possible to the upper pole. The skin is sutured over the hernial sac using interrupted silk sutures. To reduce tension, skin incisions are made in a checkerboard pattern. Muscular aponeurotic plastic surgery is performed in the second stage in children over a year old.

When using alloplastic material, the hernial sac is covered with Dacron, Teflon, suturing it along the edge of the muscular aponeurotic defect. In the next few days postoperative period the capacity of the hernial sac is reduced with the help of collecting sutures, which makes it possible to gradually immerse the organs in the abdominal cavity and perform delayed plastic surgery of the anterior abdominal wall on the 7-10th day after the birth of the child.

Newborns with small and medium-sized hernias with a well-formed abdominal cavity are subject to radical surgical intervention.

Radical surgery is reduced to excision of the umbilical membranes, reduction of the viscera and plastic surgery of the anterior abdominal wall. The operation is performed under endotracheal anesthesia. The use of muscle relaxants is undesirable, since it is not possible to timely diagnose the increase in intra-abdominal pressure that occurs with large hernias.

At the border of the skin and umbilical cord membranes, a 0.25% solution of novocaine is injected and carefully, without opening the abdominal cavity, a bordering incision is made around the hernial protrusion. The contents of the hernial sac are inserted into the abdominal cavity. The membranes are gradually excised, starting from the upper pole, and at the same time plastic surgery of the anterior abdominal wall begins. The peritoneum is sutured together with the aponeurosis, and sometimes with the edge of the muscles, using interrupted sutures. A second row of sutures is placed on the skin. If there is tension when suturing the aponeurosis, two rows of sutures (U-shaped and interrupted silk) are applied to the skin. If the hernia membranes are tightly sealed to the liver, they are left, treated with tincture of iodine and immersed together with the liver into the abdominal cavity. This is necessary due to the fact that separation of the membranes from the liver, deprived of the Glissonian capsule, leads to damage to the organ and persistent bleeding.

After Gross's operation and conservative treatment, a ventral hernia is formed (Fig. 151). For prevention severe forms for ventral hernias, after the child is discharged from the hospital, wearing a bandage, massage, and gymnastics are necessary.

Rice. 151. Ventral hernia.

Ventral hernia is eliminated surgically in children older than one year. Preliminarily carried out functional test, allowing you to find out how much the increase in intra-abdominal pressure is compensated. Blood gases are examined before and after hernia repair. The simplest tests are to determine heart rate and breathing. If after reduction of the hernia they remain within normal limits, elimination of the hernia is possible. If increased heart rate and shortness of breath are observed, surgery is postponed until the abdominal cavity has reached sufficient volume and surgery will not be possible.

The most common are two methods of plastic surgery of the anterior abdominal wall for ventral hernias.

One of them involves muscular aponeurotic plastic surgery of the defect: flaps are cut out from the outer layers of the aponeurosis, which are sutured according midline. During surgery using the Shilovtsev method, the deep-epidermalized skin flap covering the ventral hernia is displaced under the skin.

Inguinal hernia which often accompany ventral hernias, eliminate surgically 3-6 months after surgery for a ventral hernia.

Prognosis for umbilical cord hernias always serious. Mortality during surgical treatment of umbilical cord hernias remains high and ranges from 30% for small hernias to 80% for large and complicated hernias. Children successfully operated on during the neonatal period subsequently grow and develop normally.

Isakov Yu. F. Pediatric surgery, 1983

A hernia of the linea alba is also called a preperitoneal lipoma. At the same time, gaps appear in the tendon fibers between the muscles along the central line of the abdomen, through which fat leaks, and then the organs located in the abdominal cavity.

The disease manifests itself as a protrusion, which is very painful.

As soon as a hernia of the linea alba is noticed, the person should immediately seek medical attention. medical care. A surgeon treats the disease. Symptoms may include a painful protrusion, which often occurs in upper sections. Among the signs are pain manifested in the upper abdomen, which is especially true sudden movements and moments of straining. Diastasis, which is a separation of muscles, can also occur. Patients sometimes complain of nausea or vomiting.

Among the main methods for diagnosing hernia are herniography, which is X-ray method accompanied by injection into the abdominal cavity contrast agent, which allows for examination of the hernia. The patient must also undergo an ultrasound scan of the protrusion.

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Course of the disease

Hernia of the white line has several types, which depends on the location of the lesion relative to the navel. It can be located above, near or below the navel. In many cases, signs of the disease do not appear at all, and it is discovered by chance. The disease has three stages, the first of which is a preperitoneal lipoma, the second stage is represented by an initial hernia, while at the last stage a formed hernia is detected.

At the first stage, as described above, slit-like spaces are formed through which preperitoneal fat is exposed. Afterwards a hernial sac is formed, which is a sign initial stage. At the moment of muscle divergence and further development disease, part of the omentum or some area of the wall of the small intestine enters the hernial sac.

A hernia can be considered formed if a thickening appears in the area of the white line, which is painful. In this case, so-called hernial orifices are formed, which have an oval or round shape; their size in diameter can vary between 1-12 cm.

Quite often, multiple hernias form, with individual hernias located one above the other.

The pain syndrome is quite pronounced in the early stages of the development of the disease, which is caused by a strangulated hernia of the white line of the abdomen, while the nerves of the fiber of the preperitoneal region are pinched.

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Occurrence of complications

Complications can manifest as a strangulated hernia, which causes sudden compression of the hernial contents.

A strangulated hernia requires immediate assistance, the following symptoms may appear:

nausea;
the presence of blood in the stool;
for a short time, increasing pain in the abdominal area;
absence of defecation and release of gases;
vomit;
it is not possible to correct the hernia using slight pressure when the patient is in horizontal position on the back.

If a hernia of the linea alba is treated, the prognosis is favorable.

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Causes of the disease

White line abdomen is a tendon plate that is located between the rectus abdominis muscles, between the xiphoid process of the sternum and the pubis. The rectus muscle forms this area; it has tendon bridges, the number of which can vary from 3 to 6.

The causes of a hernia of the white line of the abdomen can be expressed by insufficiently developed connective tissue of the described area, which is present from birth or acquired during life. In some cases, this causes its thinning and subsequent expansion. The white line should have a width of 1 to 3 cm, while if it changes, this figure can be equal to 10 cm, this will depend on the degree of diastasis.

Hernia in this area most often occurs in men aged 20-30 years. The characteristic area of localization is the epigastric part of the linea alba.

Some have predisposing factors that influence weakening connective tissue described area, among them:

hereditary predisposition to poorly developed connective tissue;
postoperative scars;
obesity.

Risk factors associated with increased intra-abdominal pressure can be identified:

cough;
overvoltage;
constipation;
pregnancy;
ascites.

In order to prevent the possibility of the disease occurring, you can take preventive measures:

using proper technique when lifting weights;
use of a bandage during pregnancy;
abdominal muscle training;
proper nutrition;
weight adjustment;
refusal to lift excessively heavy objects.

Unfortunately, various exercises, diets and wearing a bandage will not bring any effect in this situation. The fight against a hernia can be carried out exclusively by surgical intervention, which involves hernioplasty. During the operation, the doctor gains access to the contents of the hernia. Treatment involves releasing the hernial sac, while its contents, that is, the internal organs, are immersed back into place. Afterwards, abdominal wall plastic surgery is performed.

Quite often, after a routine operation in which the surrounding tissue is sutured, the hernia appears again. For this reason in Lately To remove the hernial opening, doctors use the implantation of mesh allografts, which makes the recurrence of the disease minimal. Such grafts cannot be rejected after implantation; they take root well and prevent further tissue stretching.

There are several ways to access the site of inflammation.

The first one is open, with an incision made in the skin. After such an intervention, a suture is visible on the skin, delivering discomfort. But this technique is safer, because the doctor sees the internal organs and is able to reliably fix the allograft. If the hernia is small in size, then the intervention occurs under local anesthesia.

The second access method is laparoscopy. This is a minimally invasive method in which access is made through punctures in the abdominal wall, and examination is carried out using computer equipment. After such an operation, only barely noticeable scars will remain, pain syndrome will not be as pronounced. In this case, the surgeon may experience some difficulties in correctly securing the mesh material, this increases the likelihood reoccurrence the focus of the hernia.

After the operation, the person is under observation for 24 hours. If the hernia was of an impressive size, the patient is prescribed to wear a bandage for 30 days. After 3 months, a person is no longer prohibited from performing forceful exercise.

In addition to treating the hernia, diastasis of the abdominal muscles should be eliminated, for which exercises are prescribed. In children under 6 years of age, treatment of this disease is not carried out, but an examination by a doctor if a hernia is suspected will be necessary.

Watch the video: Live Healthy! Hernia of the white line of the abdomen

EMBRYONAL HERNIA(umbilical cord hernia, or hernia of the umbilical cord) is a developmental defect when, at the birth of a child, part of the abdominal organs is located extraperitoneally - in the umbilical membranes, consisting of amnion, Wharton's jelly and primary primitive peritoneum. The umbilical cord extends from the upper pole of the hernial protrusion. In some cases, an incompletely obliterated vitelline duct is soldered to the membranes. The size of the hernial protrusion varies and reaches a diameter of 10 cm and more. Depending on the time of occurrence of the malformation, the size of the hernia, the nature of its contents, as well as the size of the defect in the anterior abdominal wall are different. In the first days of intrauterine life, the small, underdeveloped abdominal cavity cannot accommodate the rapidly increasing abdominal organs. The latter, located extraperitoneally - in the umbilical cord membranes, go through a temporary stage of "physiological embryonic hernia". Then, as the abdominal cavity increases in size, the liver and intestinal loops return to the abdominal cavity through a “rotation process.” If, as a result of a violation of the intestinal rotation process or underdevelopment of the abdominal cavity, some organs remain in the umbilical cord membranes, the child is born with an embryonic hernia. Preserved unobliterated urachus, which connected the bladder with the allantois, or the vitelline duct, through which the intestine communicated with yolk sac, lead to the formation of congenital umbilical fistulas. If developmental arrest occurs early, then outside the abdominal cavity there is a significant part of the liver and most of the intestines, sometimes the spleen. In cases of later developmental delay, only part of the intestinal loops remains extraperitoneal. In practice, the contents of an embryonic hernia can be all organs except the rectum. If there is a defect in the diaphragm, the heart and lungs can be found in the membranes of the embryonic hernia. In cases early onset embryonic hernia, the primitive membrane tightly fuses with the surface of the liver, which is associated with underdevelopment of the Glissonian capsule of the liver.

Diagnosis It is not difficult and is performed immediately after the birth of the child.

Treatment begin upon diagnosis. The choice of treatment method depends not so much on the size of the hernial midge, but on the size of the abdominal cavity, since the immediate reduction of internal organs into an underdeveloped, small-volume abdominal cavity leads to a sharp increase in intra-abdominal pressure, limited mobility of the diaphragm and the development of severe respiratory failure, which can lead to cause of death. For small hernias, a radical operation is performed - reduction of the viscera and plastic surgery of the anterior abdominal wall. For very large hernias, as well as in cases where the abdominal cavity is underdeveloped, radical surgery is not advisable, since as a result sharp increase intra-abdominal pressure and difficulty breathing, children die very quickly. In these cases, the operation is performed using the Gross technique. Musculoaponeurotic repair for a ventral hernia is performed in these children in the second stage at an older age. Mortality during surgical treatment of embryonic hernias remained high until recently. Development specialized assistance newborns and correct surgical tactics allowed last years significantly improve results surgical treatment this severe developmental defect. In the group of children who do not have severe concomitant developmental defects, mortality has recently decreased significantly. Combined malformations (atresia of the esophagus, intestines, heart disease) sharply worsen the result of surgical intervention and increase postoperative mortality. However, despite the severity of the malformation, the prognosis with correct and timely surgical intervention should be considered quite favorable. A conservative treatment method is used for large hernial protrusions and involves the use of ointment dressings with antibiotics. In all other cases, surgical intervention is indicated, which should be as early as possible.

Fetal umbilical hernias occur in early period development of the embryo, when the abdominal wall is underdeveloped, and the intestines and liver are located outside the abdominal cavity, covered with a transparent membrane (amnion), Wharton's jelly and an internal membrane that corresponds to the parietal peritoneum. In fact, with this type of hernia, there is eventration of the abdominal organs with underdevelopment of the anterior abdominal wall, linea alba, and often in combination with splitting of the sternum and underdevelopment of the pubic joint (Fig. 24).

These defects can be combined with defects of the diaphragm, ectopia of the heart, ectopia Bladder. Due to such severe developmental defects, the child is not viable and surgical intervention is inappropriate.

Diagnosis of umbilical embryonic hernias is easy. Through translucent transparent shell peristalsis visible

tingling loops of intestines, liver, dislocating during breathing. When the child screams, the protrusion increases.

The membrane covering the insides released into the embryonic hernia sac is thin and can easily rupture during childbirth or in the first hours of the child’s life. Observation of spontaneous rupture of the membrane of an embryonic hernia is given by V.V. Gavryushov (Fig. 24, b). The entire protrusion, covered with an outer membrane, is adjacent to the skin with the formation of a well-defined skin ridge. During the first day, the transparent outer shell begins to dry out, wrinkle, and become covered with a fibrinous coating. An associated infection with subsequent suppuration leads to the development of peritonitis, from which the child dies, usually on the 3rd day of life. The size of the hernial orifice in embryonic hernias varies [up to 10x8 cm (M. P. Postolov)], hernias are usually located in the supra-umbilical region. Protrusions are also observed, which at their base have some narrowing, corresponding to the neck of the hernial sac. The umbilical cord is most often located to the left of the hernial protrusion, less often - at its apex. The abdominal organs located in the hernial sac (liver, intestines) may have fusions with each other and with the wall of the sac. The liver is often enlarged ( congestion) or atrophic, its lacing in the form of an hourglass is observed.

Fetal hernias are rare. M. S. Simanovich (1958) reports 2 cases of embryonic hernias per 7000 births.

Newborns with embryonic hernias die from pneumonia, peritonitis, and sepsis. Cases of survival are rare. V.V. Gavryushov (1962) provides an observation of a girl aged 1 year 4 months with a spontaneously healed embryonic hernia (Fig. 24, c).

a - embryonic umbilical hernia; b - rupture of the membranes of the embryonic hernia 3 hours after birth; c - embryonic (unoperated) gryn; and in a girl 1 year 4 months old (V.V. Gavryushov).

Operations for embryonic hernias. For processing surgical field recommended 5% iodine tincture, wiping the surgical field with alcohol, 5% alcohol solution tannin.

S. D. Ternovsky (1959) performs the operation according to the following plan: removal of the membrane covering the hernial protrusion, reduction of the viscera and layer-by-layer suturing of the abdominal wall. The peritoneum is sutured with interrupted sutures along with the aponeurosis, and sometimes with the edge of the muscles; a second row of sutures is placed on the skin. For small hernias, the operation is easy and can be performed under local anesthesia. With large liver prolapses, the operation becomes much more complicated, especially in cases where the wall of the sac is tightly sealed to the liver. Separation of adhesions causes significant bleeding and leads to ruptures of the liver, which does not have a capsule in this place, so it is recommended to leave the area soldered to the liver on it and, lubricated with iodine tincture, immerse it in the abdominal cavity. During surgery in early dates, as long as there is no infection, this technique is safer than forced isolation

shells. For more convenient repositioning of the viscera, it is useful to cut up and down the opening of the abdominal wall defect. With high tension of the aponeurosis tissues abdominal muscles the defect is sutured only in the lower part of the wound, and in the upper part above the liver only the skin is sutured. This technique significantly reduces intra-abdominal pressure and facilitates wound closure.

When the entire liver and intestines prolapse, partial suturing of the abdominal wall is practiced: after the intestines and part of the liver are reduced into the abdominal cavity, the unreduced part is left in the wound. The edges of the abdominal wall wound are sutured to the liver with separate sutures. This technique protects the abdominal cavity from infection. The part of the liver lying in the wound is covered granulation tissue followed by healing under a bandage.

Muscle plasticity is performed in more late dates, and the operation is thus divided into two stages. I J. Kossakovsky (Poland, 1949) makes a section within healthy skin at the base of the hernial protrusion. In case of bleeding, which may occur during the separation of membranes that have adhered to the released organs, part of the membrane is not removed. When repositioning the viscera into the abdominal cavity, it is recommended to lift the edges of the skin incision, which facilitates their gradual insertion. To facilitate the repositioning of the released viscera, a thread glove is put on the hand. If it is impossible to tighten the edges of the skin incision, two lateral loosening incisions are made, the surfaces of which are healed by subsequent granulation.

Hernias of the umbilical cord - umbilical, germinal (HERNIA FUNICULI UMBILICALIS, OMPHALOCELE)

Umbilical or embryonic hernias as a defect in fetal development are formed after the 3rd month of intrauterine life. With normal development in this period, the abdominal wall is close to its design, the umbilical cord and umbilical ring take on anatomical relationships that ensure normal development the fetus and its usefulness at the time of birth.

By 3 months, the fetal peritoneum is formed as an anatomical layer, covering the navel area; the delay in the development of the peritoneum favors the formation of a hernial protrusion.

The integument of an embryonic hernia has three layers: amnion, Wharton's jelly and peritoneum (Fig. 25). The outer shell of the hernial protrusion passes to the umbilical cord with the formation of a noticeable groove at the transition site, which is not observed in all cases. The hernial protrusion can enter the umbilical cord between the vessels, below them, and also be located to the right or left of them.

Rice. 25. Hernia of the umbilical cord (Kossakowski).

Rice. 26. Surgery for embryo-

nal hernia. Skin incision

at a distance of a few millimeters from the sac, ligation of the umbilical arteries and umbilical vein (Duhamel).

The hernial orifice usually has round shape. The umbilical cord outside the hernial protrusion has its own normal look. The hernial protrusion at its base may have a narrowed neck, and the umbilical opening is a hernial orifice. An increase in hernial protrusion occurs when the child cries. With hernias of the cord, as well as with embryonic hernias, maceration of the outer membrane occurs, its wrinkling with the gradual rejection of individual sections. Rupture of the protrusion membranes with prolapse of the abdominal viscera and subsequent development of peritonitis is also possible.

According to P.I. Tikhov, one hernia of the umbilical cord occurs in 3000-5000 births. Conservative treatment does not produce results and the only reasonable measure is urgent surgical intervention in the first hours after birth; at a later date, the outcome of the operation is unfavorable.

N.V. Schwartz (1935) proposed for large umbilical cord hernias to abandon surgery and use conservative treatment in order to achieve healing of the abdominal wall defect through scarring. Despite the fact that in the literature there is information about isolated cases of self-healing of embryonic hernias and hernias of the umbilical cord (embryonic), in this period of development of surgery it is impossible to talk about conservative treatment as a method, and the opinion of S. D. Ternovsky (1959) that protection conservative method is the “wrong direction”, quite justifiably.

Indications and contraindications for operations for embryonic hernias and hernias of the umbilical cord in each case should be made taking into account general condition newborn and associated developmental defects. A significant defect in the abdominal wall, which excludes the possibility of closing the abdominal wound, underdevelopment of the diaphragm, protrusion into the heart wall defect, and prematurity of the newborn are contraindications for surgery.

If surgery is indicated, prompt intervention is necessary within the next few hours after the birth of the child.

Before the operation, the mother is informed about the condition of the child and the indications for surgery, which is the only measure that can correct the birth defect.

At the suggestion of J. Kossakovsky, the newborn is placed on a specially prepared cruciform plate, the limbs are fixed with soft bandages.

Surgery for umbilical cord hernias is performed from an oval incision surrounding the base of the hernial protrusion. Next, the tissues are separated layer by layer, the hernial sac is opened, and the existing adhesions are separated. If bleeding occurs when separating membranes that have adhered to the removed organs, some of the membranes may not be removed. The umbilical vein and arteries are ligated; the peritoneum and aponeurosis are sutured separately if possible (Fig. 26). When introducing organs into the abdominal cavity, it is recommended to raise the edges of the skin incision. If it is impossible to tighten the edges of the skin incision, two lateral loosening incisions are made, the surfaces of which are healed by granulation (J. Kossakovsky).

Hernia is a fairly common ailment among both adults and children. Its most common type, fetal hernia, is being actively studied today. Measures aimed at its prevention are also being intensively developed. Indeed, according to statistics, 20% of newborns and 35% of premature babies suffer from this disease.The second name for an embryonic hernia is umbilical. What is the cause of this illness? The fact is that some organs located in the child’s abdominal cavity are outside its space at the time of birth, that is, they protrude through the umbilical ring. The strip where the ring is located runs through the middle of the abdomen and is made up of ligaments, forming the umbilical cord. When the baby is born, it is ligated and the umbilical cord is removed. Over time, the vessels heal and scar. As a result, the opening of the umbilical ring is blocked.

Reasons for the development of fetal hernia

But if sufficient time for healing has not yet passed, and the pressure on the abdomen increases, there is a risk of a fetal hernia. After all, then the umbilical ring can protrude big oil seal and the edge of the intestine. Under the skin, such a hernia looks like a soft ball, the outlines of which are drawn during a child’s screaming and crying, and difficult bowel movements.There are several main reasons for the development of fetal hernia in children, but to date they have been little studied. Of these, hereditary predisposition, as well as negative impact on the fetus during pregnancy from the outside. The connective tissue contains collagen fibers that develop very slowly, resulting in an incorrectly formed structure of the umbilical ring. To summarize, we can conclude that many factors can influence the slow process of ring closure. As a result, a free space is formed under the navel, previously occupied by blood vessels, and this becomes the first prerequisite for the formation of a hernia.

After breast augmentation surgery

Symptoms fetal hernia

Symptoms by which the progression of the disease can be determined are nausea, an enlarged umbilical ring, a softly protruding navel area, the appearancepain in the lower abdomen during physical activity or cough. A fetal hernia can be diagnosed in the womb. An increase in alpha-fetoprotein in the second trimester of pregnancy will indicate the occurrence of this disease very eloquently. As well as the abdominal wall defect detected on ultrasound.In terms of size, hernias are small, their diameter is up to 5 cm, medium (up to 10 cm in diameter) and large, representing seals from 10 cm. According to the degree of complexity - complicated (when the membranes become infected) and uncomplicated.Fortunately, as practice shows, in 99% of cases, a sick child recovers on his own. The hernia may close before the age of three. But only when the diameter of the compaction is no more than 1.5 cm, and the sick child is physically active, and bowel function is normalized. Also in such cases, the child is prescribed a massage and enrolled in exercise therapy. The massage is performed with soft, painless techniques that do not cause children to cry. Before starting the massage, you need to straighten the seal with gentle pressure from the fingers of your hand, and start massaging with the other.

Events

Exercise therapy is useful in that it strengthens the child’s body as a whole, has a general developmental effect, strengthens muscles, normalizes excitability, and supports psychomotor development at the appropriate age. But exercise therapy is possible only after the lump in the tummy has been adjusted and secured with a bandage. Extremely important role plays nutrition of mother and child. It is important for the mother during the feeding period. It is necessary to exclude from the diet all foods that cause increased gas formation, make bowel movements difficult, accumulate gases and cause colic, and also study the issuewhat is mastopathy and how to recognize it . One of the methods aimed at treating fetal hernia in children is positional treatment. In this therapy, the baby is placed on his tummy. This position will allow the baby to move his arms and legs diligently, helps the gases to escape and prevents the hernia from protruding, as intra-abdominal pressure decreases.

Treatment of cystic fibroadenomatosis

Complications

However, an embryonic hernia can also cause complications, manifested in intestinal obstruction, inflammation, damage and the occurrence of neoplasms. In this case, surgery cannot be avoided. As in the case when the hernia has reached an alarming size or the umbilical ring has not closed and disappeared before reaching one year of age. Only very careful monitoring of the child’s condition and the seal, as well as regular examinations and visits to the doctor, will increase the chance of spontaneous resorption of the hernia.