Infant umbilical hernia

　　Due to developmental defects in the umbilicus, the umbilical ring has not closed, or the umbilical cord root tissue is poorly adhered to the umbilical ring after the umbilical cord is shed, resulting in poor healing. Under conditions of increased abdominal pressure, the omentum or intestine can protrude through the weak area of the umbilicus to form an umbilical hernia. Most umbilical hernias in infants and young children are caused by congenital developmental abnormalities, including the umbilical ring not closing or the umbilical ring surrounding scar tissue being thin, leading to the formation of umbilical hernia; while umbilical hernias in adults are often caused by acquired factors, such as pregnancy, ascites, abdominal tumors, excessive obesity, and other reasons, leading to weakened tissue around the umbilicus and a decrease in the ability to resist the rise of abdominal pressure.

　　Hernia can weaken the muscles near the inguinal canal at the site where the canal is full, causing the small intestine to be affected by abdominal pressure and be pushed into the inguinal canal. If it occurs in a male baby, it may even run into the scrotum, causing the affected inguinal canal and scrotum to appear particularly swollen and thus block the herniated intestine. At this time, the herniated mass at the umbilical ring will also become hard, causing the body to produce a sensation of pain and resistance when it is retracted.

　　A hemispherical mass in the umbilicus, a moist and smelly umbilical fossa, swelling around the umbilicus, a cherry-red polyp-like mass in the umbilical fossa, obvious redness, swelling, and hardening around the umbilicus, and a large amount of purulent exudate around the umbilicus, infants and young children with umbilical swelling have a bulge protruding from the umbilicus

　　An umbilical swelling that can be restored is the most important clinical manifestation, especially obvious during an infant's crying, generally without other symptoms. Since the infant's abdominal wall and hernia ring are both soft, incarceration is very rare. Swelling around the umbilicus, which is a hemispherical mass in the umbilicus, swelling around the umbilicus, a moist and swollen umbilical fossa, and exudate with an unpleasant smell, can be purulent or mixed with blood, all of which are symptoms of umbilical erysipelas.

　　Some umbilical rings are too small, and children are prone to crying and fussing. For those who frequently experience umbilical hernia incarceration, the 'adhesive tape method' can be tried to accelerate the closure of the umbilical orifice. The adhesive tape should be medical-grade tape, about 5 centimeters wide, and longer than the child's waist circumference by 6-10 centimeters. One end of the tape should be cut into a small tongue-like extension (about 5 centimeters long), and the middle of the other side of the tape should be cut open to allow the tongue-like tape from the opposite side to be inserted and then粘贴. The waist and back area through which the tape passes can be lined with gauze, and the tape must be applied to make the hernia sac empty or凹陷. Generally, it should be changed 1-2 times a week, and it can be continuously used for 3-6 months. Attention should be paid to protecting the skin to prevent blisters and ulcers. The key to applying the tape is to apply it moderately tightly, making the umbilical orifice smaller with each application to promote healing. To prevent the tape from slipping, an elastic band (a tension band) can also be added on the outside. Due to the certain difficulty and complications associated with tape application, the above operations should be performed by medical personnel. Another method is the 'elastic abdominal band', which is particularly suitable for newborns and infants. It can be used first, usually worn during the day and loosened during sleep, and the tightness should be adjusted frequently to prevent the umbilical hernia from protruding excessively while ensuring the child's food intake and abdominal development. The operation of the elastic abdominal band is relatively simple, and parents can completely handle it, and it is also welcomed by parents who are overly worried (especially those who hope their baby can receive treatment). Some parents continue to use old habits, such as using large copper coins or coins tied with a cloth band to tighten the abdomen, in an attempt to block the protrusion of the umbilical hernia. This not only has no effect but may also cause injury, so it should be abandoned.

　　According to the symptoms of infants with umbilical hernia, an abdominal X-ray film is generally needed to understand whether there are signs of intestinal obstruction. Or abdominal percussion, which is an auxiliary examination method used to check whether the abdomen is normal.

　　For the diet of infants with umbilical hernia, attention should be paid to avoiding crying and闹闹, and reasonable feeding, strengthening nutrition, which is conducive to the accumulation of abdominal wall fat, reducing the occurrence of umbilical hernia. If the child has added complementary foods, attention should be paid to avoid indigestible foods, and the diet should be light, with less spicy, fried, and fried foods that are difficult to digest and irritant. Eat more fruits, vegetables, and fibrous foods, and drink more water. Pay attention to eating foods rich in vitamin A, carotene, and vitamin B.

　　Smaller umbilical hernias, such as those with a diameter less than 1.5 cm, can often heal spontaneously with the strengthening of the abdominal wall during development within 2 years. In view of the rare occurrence of incarceration in umbilical hernias in infants, non-surgical treatment can be considered first, using adhesive bandage therapy, that is, use a wide strip of adhesive bandage to pull the abdominal wall on both sides towards the midline and apply it to fix the hernia mass, and keep the umbilicus in a tension-free state, allowing the umbilical orifice to gradually heal and close. Change the bandage once a week, and if there is adhesive dermatitis, switch to an abdominal binder for appropriate pressure wrapping.

　　If the umbilical hernia has not healed spontaneously by the age of 2, surgical treatment should be considered. The specific method of surgery is to make a corresponding arched incision 1-2 cm below the umbilical hernia, free the skin flap, and expose the anterior sheath of the rectus abdominis on both sides. Incise the linea alba and hernial sac, and if there is no complete hernial sac, incise the peritoneum. Push the intestine back, excise the hernial sac, and suture the peritoneal margin at the hernial ring. Suture the transversalis fascia horizontally, then suture the linea alba longitudinally to close the umbilical ring and repair the fragile area of the abdominal wall. Finally, suture the skin flap with the umbilicus in place.