Pediatric surgery. Hernia of the umbilical cord. Clinic (most important)

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Pediatric surgery. Hernia of the umbilical cord. Clinic (most important)

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29. Hernia of the umbilical cord. Clinic.

Hernia of the umbilical cord has a typical appearance. At the first examination after birth, a child is found in the center of the abdomen with a tumor-like protrusion that is not covered by skin, emanating from the base of the umbilical cord. The protrusion has all the elements of a hernia: a hernial sac, consisting of stretched amniotic membranes, a hernial ring formed by the edge of a skin defect and aponeurosis, as well as the contents of the hernia - the abdominal organs.

Uncomplicated hernia of the umbilical cord covered with moist smooth, grayish, stretched amniotic membranes. In the first hours after birth, the membranes are so transparent that you can see the contents of the hernia: the liver, intestinal loops, stomach and other organs.

In some cases, the skin spreads on the base of the hernia in the form of a ring up to 1,5-2 cm high. The shape of the hernial protrusion is more often hemispherical, spherical and mushroom-shaped. Small hernias of the umbilical cord sometimes resemble an enlarged umbilical cord.

The contents of small hernias is the intestines. The general condition of such newborns does not suffer. Medium-sized hernias are filled with a significant number of intestinal loops and may contain part of the liver.

Complications of hernias of the umbilical cord have a peculiar clinical picture, are congenital or acquired.

The most severe complication is rupture of the hernial sac membranes. A child is born with intestinal loops falling out of the abdominal cavity.

Ectopia of the heart occurs in children with large hernias of the umbilical cord. Diagnosis of the defect is simple, since upon examination, a pulsating protrusion is clearly defined in the upper part of the hernia under the amniotic membranes - displaced heart.

Incomplete reverse development (non-closure) of the vitelline duct is detected during the first careful examination of the hernial protrusion: at the base of the umbilical residue, intestinal fistula with bright red edges of everted mucous membrane.

Bladder exstrophy often combined with a hernia of the umbilical cord. In the presence of these defects, the abdominal wall is absent almost throughout.

congenital intestinal obstruction - the most "insidious", from the diagnostic point of view, the combined malformation.

More often there is a high obstruction due to duodenal atresia or a violation of the normal rotation of the middle intestine.

Severe congenital heart defects sharply worsen the general condition of the newborn and are detected by the corresponding set of clinical signs.

Purulent fusion of the superficial membranes of the hernial sac inevitably occurs in cases where the child was not operated on the first day after birth. In such children, the hernial protrusion is a dirty gray purulent wound with mucous discharge and areas of necrosis in the form of dark clots.

Authors: Drozdov A.A., Drozdova M.V.

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