Umbilical hernia in adults - symptoms, treatment and consequences. Umbilical hernia of newborns: care, prevention, treatment Umbilical ring anatomy

navel, umbilical region [umbilicus(PNA, JNA, BNA); regio umbilicalis(PNA, BNA); pars (regio) umbilicalis(JNA)].

umbilical region (regio umbilicalis) - part of the anterior abdominal wall, located in the mesogastric region (mesogastrium) between two horizontal lines (of which the upper one connects the ends of the bone parts of the tenth ribs, and the lower one - the upper anterior iliac bones) and limited laterally by semi-oval lines corresponding to the outer edges of the rectus abdominis muscles . In the umbilical region, the greater curvature of the stomach is projected (when it is filled), the transverse colon, loops of the small intestine, the horizontal (lower) and ascending parts of the duodenum, the greater omentum, the lower internal sections of the kidneys with the initial sections of the ureters, partially the abdominal part of the aorta, the inferior vena cava and lumbar nodes of the sympathetic trunks.

Navel is a skin cicatricial fossa located in the umbilical region and formed after the birth of a child as a result of the fall of the umbilical cord (see).

Navel formation

The formation of the navel is preceded by complex developmental processes in the prenatal period, when the fetus is connected to the placenta by the umbilical cord. Its constituent elements undergo significant changes in the course of development. So, the yolk sac in mammals is a rudimentary formation left outside the body of an early embryo, a cut can be considered part of the primary intestine. The yolk sac is connected to the primary intestine through the umbilical-intestinal (yolk) duct. The reverse development of the yolk sac begins at the 6-week-old embryo. Soon it will be reduced. The umbilical-intestinal duct also atrophies and disappears completely. The umbilical cord contains the alantois, which opens into the hindgut (more precisely, the cloaca) of the embryo. The proximal part of the allantois expands during development and participates in the formation of the bladder. The stalk of allantois, also located in the umbilical cord, is gradually reduced and forms the urinary duct (see), which serves in the embryo to divert primary urine into the amniotic fluid. By the end of the intrauterine period, the lumen of the urinary duct usually closes, it is obliterated, turning into the median umbilical ligament (lig. umbilicale medium). In the umbilical cord, umbilical vessels pass, which are formed by the end of the 2nd month of the prenatal period due to the development of placental circulation. The formation of the navel occurs after birth due to the skin of the abdomen passing to the umbilical cord. The navel covers the umbilical ring (anulus umbilicalis) - an opening in the white line of the abdomen. Through the umbilical ring, the umbilical vein, umbilical arteries, urinary and vitelline ducts penetrate into the abdominal cavity of the fetus in the prenatal period.

Anatomy

There are three forms of the umbilical fossa: cylindrical, cone-shaped and pear-shaped. The navel is most often in the middle of the line connecting the xiphoid process of the sternum with the pubic symphysis, and is projected onto the upper edge of the fourth lumbar vertebra. The navel can be retracted, flat and protruding. It distinguishes: a peripheral skin roller, an umbilical groove corresponding to the line of adhesion of the skin with the umbilical ring, and a skin stump - a nipple, formed as a result of the umbilical cord falling off and subsequent scarring. The umbilical fascia is part of the intraperitoneal fascia (fascia endoabdominalis). It can be dense and well-defined, its transverse fibers, woven into the posterior walls of the sheaths of the rectus muscles, close and strengthen the umbilical ring; sometimes the umbilical fascia is weak, loose, which contributes to the formation of umbilical hernias. With a well-defined umbilical fascia, there is an umbilical canal formed in front by the white line of the abdomen, behind - by the umbilical fascia, from the sides - by the sheaths of the rectus abdominis muscles. The umbilical vein and arteries pass through the canal. The lower opening of the canal is located at the upper edge of the umbilical ring, and the upper one is 3-6 cm above it. The umbilical canal is the exit point of oblique umbilical hernias (see). When it is not expressed, there are hernias, called direct.

From the side of the abdominal cavity, there are four peritoneal folds leading to the umbilical ring: a round ligament of the liver (lig.teres hepatis) approaches its upper edge - a partially obliterated umbilical vein; to the lower edge - the median umbilical fold (plica umbilicalis mediana), covering the obliterated urinary duct, and the medial umbilical folds (plicae umbilicales mediales), covering the obliterated umbilical arteries.

The umbilical region is characterized by a peculiar vascularization associated with the restructuring of blood circulation at birth. The arteries of the umbilical region are branches of the superficial, superior and inferior epigastric, superior cystic, and umbilical arteries, which maintain patency in a certain part and in the postnatal period. Through them, you can enter contrast agents into the abdominal part of the aorta to contrast the aorta and its branches - transumbilical aortography (see Catheterization of the umbilical vessels), as well as drugs for newborns. Branches of the superior and inferior epigastric arteries form anastomosing rings around the navel: superficial (cutaneous-subcutaneous) and deep (muscular-subperitoneal).

From the veins of the umbilical region, the portal vein system (see) includes the umbilical vein (v. umbilicalis) and paraumbilical veins (vv. paraumbilicales), the system of the inferior vena cava (see Vena cava) - superficial and lower epigastric (vv. epigastricae superficiales et inf.) and to the system of the superior vena cava - superior epigastric veins (vv. epigastricae sup.). All these veins form anastomoses among themselves (see Portocaval anastomosis). The umbilical vein is located between the transverse fascia of the abdomen and the peritoneum. By the time of birth, the length of the umbilical vein reaches 70 mm, the diameter of the lumen at the confluence with the portal vein is 6.5 mm. After the umbilical cord is tied, the umbilical vein becomes empty. By the 10th day after birth, atrophy of muscle fibers and proliferation of connective tissue in the wall of the umbilical vein are noted. By the end of the 3rd week. life, atrophy of the vein wall, especially near the navel, is clearly expressed. However, in newborns and even in older children, the umbilical vein can be isolated from the surrounding tissue, awakened, and used as access to the vessels of the portal vein system. Considering this communication, an umbilical vein already right after the birth can be used for to lay down. measures (replacement transfusion for hemolytic disease of the newborn, regional perfusion of drugs for resuscitation of newborns, etc.).

The umbilical vein is used during portomanometry and portohepatography (see Portography). The portogram with normal portal circulation clearly shows the place where the umbilical vein flows into the portal vein, and it is also possible to obtain a clear image of the intrahepatic ramifications of the portal vein. Contrasting of the liver vessels on portohepatograms obtained with the introduction of a contrast agent through the umbilical vein is more distinct than on splenoportograms. G. E. Ostroverkhoe and A. D. Nikolsky developed a simple extraperitoneal access to the umbilical vein, which allows adults to use it for angiography in liver cirrhosis, as well as in primary and metastatic liver cancer.

In the umbilical region there is a network of limf, capillaries that lie under the skin of the umbilical groove and along the posterior surface of the umbilical ring under the peritoneum. Of these, the lymph flow goes in three directions: in the axillary, inguinal and iliac limf. nodes. According to H.H. Lavrov, the movement of lymph is possible along these paths in both directions, which explains the infection of the umbilical region and the navel from the primary foci in the axillary and inguinal regions.

The innervation of the upper umbilical region is carried out by the intercostal nerves (nn. intercostales), the lower - by the iliohypogastric nerves (nn. iliohypogastrici) and the ilioinguinal (nn. ilioinguinales) nerves from the lumbar plexus (see. Lumbosacral plexus).

Pathology

In the umbilical region, various malformations, diseases, tumors can be noted. The reaction of the navel to a change in pressure inside the abdomen (protrusion with ascites, peritonitis) was noted. In acute and chronic inflammatory processes in the abdominal cavity, the navel may shift to the side. With a number of patol, conditions, a change in the color of the skin of the navel is observed: it is yellow with bile peritonitis, cyanotic with cirrhosis of the liver and congestion in the abdominal cavity. In some pathological conditions in adults, for example, the Cruveil-Baumgarten syndrome (see Cruvelier-Baumgarten syndrome), there is a complete patency of the umbilical vein with a significant expansion of the superficial veins of the umbilical region, splenomegaly, and a loud blowing noise in the umbilical region.

Malformations are the result of a violation of the normal development or a delay in the reduction of formations passing through the umbilical region in the early stages of embryogenesis (hernias, fistulas, cysts, etc.).

Hernias. Slow growth and closure of the lateral processes of the primary vertebrae or impaired intestinal rotation in the first period of rotation lead to the development of an embryonic hernia (hernia of the umbilical cord, umbilical hernia), which is detected at birth; with this hernia, the umbilical membranes perform the functions of a hernial sac (see Hernias, in children). Weakness of the muscles of the anterior abdominal wall, umbilical fascia in the upper semicircle of the umbilical ring can lead to the formation of an umbilical hernia. They are revealed later, when the navel has already formed. Hernial protrusion in children (more often in girls) occurs with a strong tension of the abdominal press when coughing, screaming, constipation, and also as a result of general weakness of the muscles; in adults, umbilical hernias are more common in women. Treatment is operative.

Fistulas and cysts. With a delay in obliteration of the urinary duct, it can remain open throughout (this leads to the formation of a vesico-umbilical fistula) or in separate areas, which contributes to the occurrence of cysts of the urinary duct, umbilical fistula, bladder diverticulum (see Urinary duct).

With a delay in the reverse development of the umbilical-intestinal (yolk) duct, such defects as Meckel's diverticulum (see Meckel's diverticulum), complete umbilical-intestinal fistula (complete fistula of the navel), incomplete fistula of the navel and enterocyst occur.

Rice. 1. Schematic representation of some malformations of the navel (sagittal section): a - complete fistula of the navel and b - incomplete fistula of the navel (1 - fistula opening, 2 - fistula of the navel, 3 - small intestine); c - navel enterocyst (1 - abdominal wall, 2 - enterocyst, 3 - small intestine).

Complete fistula of the umbilicus develops if the umbilical-intestinal duct after the birth of a child remains open throughout (Fig. 1, a). A wedge, a picture of this pathology is typical. In a newborn, immediately after the umbilical cord falls off, gases and liquid intestinal contents begin to leave the umbilical ring, this is due to the fact that the duct connects the umbilical fossa with the terminal ileum. Along the edge of the umbilical ring, a corolla of the mucous membrane of a bright red color is clearly visible. With a wide fistula, the constant secretion of intestinal contents depletes the child, the skin around the umbilical ring quickly macerates, and inflammatory phenomena join. Possible evagination (prolapse) of the intestine with impaired intestinal patency. Diagnosis does not present significant difficulties, in unclear cases they resort to probing the fistula (the probe passes into the small intestine) or perform contrast fistulography (see) with iodolipol.

Treatment of a complete fistula of the navel is operational. The operation is carried out under anesthesia, the fistula is preliminarily plugged with a thin turunda and sutured, which prevents possible infection of the wound. The fistula is excised all over with a delineating incision. Often, with a wide base of the fistula, a wedge-shaped resection of the intestine is performed. The intestinal wall defect is sutured with a single- or double-row intestinal suture at an angle of 45° to the axis of the intestinal wall. The prognosis is usually favorable.

Incomplete umbilical fistula(Fig. 1, b) is formed with a partial violation of the reverse development of the umbilical-intestinal duct from the side of the abdominal wall (if the duct is open only in the umbilical region, this pathology is called Roser's hernia). Diagnosis of this malformation is possible only after the umbilical cord falls off. In the field of an umbilical fossa there is a deepening, from to-rogo mucous or mucopurulent liquid is constantly allocated. The end of the duct in these cases is lined with an epithelium identical to the intestinal one, which secretes mucus. Secondary inflammatory phenomena quickly join. The diagnosis is clarified by probing the fistula and determining the pH of its discharge.

Differential diagnosis is carried out with incomplete fistulas of the urinary duct (see Urinary duct), proliferation of granulations at the bottom of the umbilical fossa - fungus (see below), omphalitis (see) and calcification of the tissues of the umbilical region (see below).

Treatment of an incomplete fistula of the navel begins with conservative measures. The wound is regularly cleaned with a solution of hydrogen peroxide, followed by cauterization of the walls of the fistulous passage with 5% alcohol solution of iodine or 10% solution of silver nitrate. Possible cauterization with a lapis pencil. With the ineffectiveness of conservative treatment at the age of 5-6 months. perform surgical excision of the fistula. In order to avoid infection of the surrounding tissues and subsequent suppuration of the wound, the fistula is carefully treated with 10% alcohol solution of iodine and 70% alcohol beforehand.

A complication of a complete or incomplete fistula is calcification of the umbilicus, which is characterized by the deposition of calcium salts (Fig. 2) in the tissues of the umbilical ring and the umbilical region. In the subcutaneous tissue of the umbilical region, foci of compaction appear, secondary inflammatory changes in the affected tissues join, which make it difficult or impossible to epithelialize:) the umbilical wound. A wedge develops, a picture of a long-term weeping navel - the umbilical wound heals poorly, gets wet, serous or serous-purulent discharge is released from it. There is no fistulous tract or proliferation of granulations with calcification. The edges and bottom of the umbilical wound are covered with necrotic tissues. The diagnosis of calcification of the navel is made by the presence of seals in the tissues of the umbilical ring and the umbilical region. In doubtful cases, a survey radiography of the soft tissues of the umbilical region in two projections is shown. On radiographs, calcifications look like dense foreign inclusions. Treatment of calcification of the navel consists in removing calcifications by scraping with a sharp spoon or surgical excision of the affected tissues.

Enterocyst- a rare congenital, fluid-filled cyst, the structure of the wall of the cut resembles the structure of the intestinal wall. It comes from the wall of the middle section of the umbilical-intestinal duct. Enterocysts in some cases lose their connection with the intestine and are located in the abdominal wall under the peritoneum, in others they are located near the small intestine and are connected to it by a thin leg (Fig. 1. c). Enterocyst can fester and cause local or diffuse peritonitis (see).

Enterocysts located in the abdominal cavity must be differentiated from lymphatic cysts arising from embryonic limf, formations (see Lymphatic vessels), as well as with dermoid cysts (see Dermoid), which are derivatives of the ectoderm, laced off in the embryonic period and immersed in the underlying connective the cloth. Treatment of enterocysts is operative.

Malformations of the vein and arteries of the umbilical cord. The absence of the umbilical vein or malformations of its development lead, as a rule, to intrauterine death of the fetus. The umbilical arteries may be asymmetrical or one of the arteries may be missing. This pathology is often combined with malformations of the abdominal organs, for example, with Hirschsprung's disease (see Megacolon), or retroperitoneal space, for example. with malformations of the kidneys (see), ureters (see).

Skin navel- one of the frequent malformations of the navel. In this case, there is an excess of skin, which persists in the future. It is considered only as a cosmetic defect. Treatment is operative.

amniotic navel- a relatively rare anomaly, with a cut, the amniotic membranes from the umbilical cord pass to the anterior abdominal wall. After the remnant of the umbilical cord falls off, an area 1.5-2.0 cm in diameter remains on the anterior abdominal wall, devoid of normal skin and gradually epidermis. This area must be carefully protected from accidental injury and infection.

Diseases. The mummified umbilical cord usually falls off on the 4-6th day of life, and the remaining umbilical wound, with normal granulation, epithelizes and heals by the end of the 2nd - the beginning of the 3rd week. At infection of the umbilical cord it does not mummify and does not fall off in a timely manner, but remains moist, acquires a dirty brown color and emits an unpleasant fetid odor. This pathology is called gangrene of the remainder of the umbilical cord (sphacelus umbilici). Further the umbilical cord disappears then the infected, strongly festering and badly healing umbilical wound usually remains, in a cut gaping umbilical vessels are visible. Often gangrene of the remainder of the umbilical cord can cause the development of sepsis (see). Treatment is complex, including the appointment of broad-spectrum antibiotics.

At pyorrhea or pyorrhea of ​​the umbilicus caused by streptococci and staphylococci or gonococci and other pathogens, discharge from the umbilical wound becomes purulent and accumulates in significant quantities in the folds and depressions of the emerging navel. Treatment is local (treatment of the wound with potassium permanganate solution, physiotherapeutic procedures) and general (prescription of antibiotics).

Rice. 1-3. Rice. one. Inflammation of the umbilicus with ulceration (ulcus umbilici). Rice. 2. Mushroom-like growth of granulation tissue in the navel (fungus umbilici). Rice. 3. Spread of the inflammatory process from the navel to the surrounding skin and subcutaneous tissue (omphalitis).

The prolonged healing of a festering umbilical wound can lead to ulceration of its base, which in these cases is covered with a serous-purulent discharge of a grayish-greenish color - an umbilical ulcer (ulcus umbilici) - color. rice. 1. With prolonged healing of the umbilical wound, the granulation tissue can grow and a small tumor is formed - the navel fungus (fungus umbilici) - color. rice. 2. Local treatment - cauterization of the wound with 2% solution of silver nitrate, its treatment with a strong solution of potassium permanganate or brilliant green solution.

Abundant inflammatory discharge from the umbilical wound is sometimes the cause of irritation and secondary infection of the skin around the navel. Small and sometimes larger pustules appear - pemphigus periumbilical is. Treatment consists in opening pustules and treating them with disinfectant solutions; with a common process, antibiotic therapy is prescribed.

If the inflammatory process from the umbilical wound passes to the skin and subcutaneous tissue, omphalitis develops around the navel (tsvetn. Fig. 3), the course of which may be different. There are several forms: simple omphalitis (weeping navel), phlegmonous and necrotic omphalitis (see).

In some cases, the infection spreads through the umbilical vessels, most often through the sheath of the artery, and passes to the vascular wall, which leads to the development of umbilical periarteritis. Inflammation of the umbilical vein is observed much less frequently, but is more severe, because the infection spreads through the portal vein system to the liver, causing diffuse hepatitis, multiple abscesses and sepsis. If the inflammatory process from the vessels or surrounding tissues passes to the connective tissue and fiber of the anterior abdominal wall, then preperitoneal phlegmon develops. The treatment is complex, includes antibiotic therapy and is aimed at preventing the development of sepsis.

It is possible to infect the umbilical wound with the causative agent of diphtheria (diphtheria of the navel), mycobacteria (tuberculosis of the navel). Treatment is specific (see Diphtheria, Tuberculosis).

Umbilical bleeding. There are bleeding from the umbilical vessels and parenchymal bleeding from the granulating umbilical wound. Umbilical bleeding occurs due to insufficiently thorough ligation of the umbilical cord or as a result of an increase in blood pressure in the artery with circulatory disorders in the small circle, which is most often observed in children born in asphyxia, as well as in premature infants with pulmonary atelectasis and congenital heart defects. Violation of the process of normal obliteration of the umbilical vessels, delayed thrombus formation in them due to a violation of the coagulating properties of the child's blood or the subsequent melting of a thrombus under the influence of secondary infection can also be the cause of vascular umbilical bleeding.

Treatment is surgical and consists in re-ligation of the umbilical cord, as well as the appointment, according to indications, of drugs that increase blood clotting.

Tumors. In the umbilical region, benign and malignant tumors are observed, sometimes metastases of various malignant tumors, for example, ovarian cancer, are noted. Rarely, tumors originating from the urinary duct (urachus) are encountered. Among benign tumors of the navel and umbilical region there are fibroma (see Fibroma, fibromatosis), leiomyoma (see), lipoma (see), neurinoma (see), neurofibroma (see), hemangioma (see).

Tumors of the urinary tract occur predominantly in men over 50 years of age. Complaints of pain appear, hematuria is sometimes noted, and a tumor-like formation in the abdominal wall can be determined on palpation. By localization, tumors located in the wall of the bladder (usually colloidal adenocarcinoma), tumors located between the bladder and the navel (usually fibroma, myoma, sarcoma) and tumors in the navel (usually adenoma, fibroadenoma) are distinguished. Metastases of tumors of the urinary duct are rare. Quite often tumors arise in the field of umbilical fistula and, as a rule, do not reach the big sizes. With colloid adenocarcinoma, a gelatinous mass may be released from the umbilical fistula or ulcer. Malignant tumors can grow into the abdominal cavity and its organs.

Treatment of tumors of the urinary duct is only surgical. All tumors of the urinary duct are not sensitive to radiation therapy and antitumor agents. Immediate results of surgical treatment are good. Long-term results have been studied little. Relapses appear within 3 years, and in later periods are observed in individual patients.

Bibliography: Babayan A. B. and Sosnina T. P. Anomalies of development and diseases of the organs associated with the umbilical ring, Tashkent, 1967; Doletsky S. Ya. and Isakov Yu. F. Children's surgery, part 2, p. 577, M., 1970; Doletsky S. Ya., Gavryushov V. V. and Akopyan V. G. Surgery of newborns, M., 1976; Doletsky S. Ya., etc. Contrast studies of the portal vein and aorta system through the umbilical vessels in children, M., 1967; Operative surgery with topographic anatomy of childhood, ed. Yu. F. Isakov and Yu. M. Lopukhin, Moscow, 1977; Ostroverkhov G. E. and Nikolsky A. D. To the technique of portography, Vestn. hir., t. 92, No. 4, p. 36, 1964; Tur A. F. Physiology and pathology of the period of the Newborn, p. 213, L., 1955; Surgical anatomy of the abdomen, ed. A. N. Maksimenkova, p. 52, L., 1972; Surgery of malformations in children, ed. G. A. Bairova, L., 1968.

V. A. Tabolin; V. V. Gavryushov (malformations), A. A. Travin (an.).

Navel, umbilicus, is a retracted scar of the skin approximately in the middle of the white line at the site of the umbilical ring.

umbilical ring, anulus umbilicalis, - a hole in the white line with sharp and even edges formed by the tendon fibers of the aponeuroses of all the broad abdominal muscles. In the intrauterine period, the umbilical cord passes through the umbilical ring, connecting the fetus to the mother's body. In this hole, along the lower semicircle, there are two umbilical arteries and the urinary duct (urachus), on the upper semicircle - the umbilical vein. In adults, these formations are neglected. Near the umbilicus are paraumbilical veins, w. paraumbilical, connecting the superficial veins of the abdominal wall with the portal vein system.

AT composition of the navel includes the following layers: skin, scar tissue, transverse fascia and parietal peritoneum, tightly fused together. There is no subcutaneous or preperitoneal tissue. Due to the lack of muscular coverage, the navel is another “weak spot” in the abdominal wall where umbilical hernias often occur.

Intra-abdominal fascia, fascia endoabdominalis, forms the visceral fascia of the abdominal organs, the retroperitoneal sheet and the parietal sheet. Fascia abdominis parietalis lines the abdominal wall from the inside. Depending on the muscle it covers, it has different names: f. diaphragmatica, f. psoatica, etc. That part of the parietal fascia, which is adjacent to the transverse abdominal muscle, is called the transverse fascia, fascia transversalis.

In the upper abdomen, the transverse fascia is thin, below, especially closer to the inguinal ligament, it thickens, turning into a fibrous plate. This thickening is called iliopubic tract tractus iliopubicus. It is attached, as well as the inguinal ligament, lig. inguinale, to the pubic tubercle and the anterior superior iliac spine and runs parallel to the inguinal ligament posterior to it. They are separated only by a very narrow gap, therefore, in surgery, the complex of these two ligamentous formations is often referred to by one term: the inguinal ligament.

Approximately halfway through iliopubic tract and the inguinal ligament immediately above them, the transverse fascia forms a funnel-shaped protrusion that runs between the broad muscles of the abdomen, in the inguinal canal. The beginning of this protrusion is deep inguinal ring, anulus inguinalis profundus, and the continuation going inside the inguinal canal is called internal seminal fascia, fascia spermatica interna. In males, this fascia forms the sheath of the spermatic cord.

An umbilical hernia in an infant is a congenital defect in the umbilical ring, through which the contents of the abdominal cavity can exit, but do not be afraid: in most cases, an umbilical hernia is an intestinal loop, and doctors successfully cope with this phenomenon.

TREATMENT OF UMBILICAL HERNIA

Not so long ago, one could hear the recommendation to put circles of hard material on the hernia and bandage them tightly. Today, this method is no longer resorted to, since it is not effective: even pressed down by a circle from above, the protruding part of the internal organ does not allow the umbilical ring to heal. A competent doctor will set the hernia inward, connect the skin near the navel into a longitudinal or transverse fold and fix it with a band-aid. This type of compression bandage will prevent the internal organs from “peeping out” and help the umbilical ring tighten. The patch is applied for ten days.

On the first day with a patch, the baby is usually not bathed, and on the remaining days you can carry out all hygiene procedures as usual, bathe the baby. After the indicated ten days, the surgeon should examine the baby, remove the patch and check the condition of the navel. Further treatment is determined according to the result. It is quite possible that after several “sessions” with the patch, the umbilical ring will tighten.

If, by the age of two months, wearing a patch does not give tangible results, it is advisable to refuse it. The baby's abdominal muscles have already strengthened, the skin has become quite elastic, and the patch can stretch it too much, causing irritation.

MASSAGE OF UMBILICAL HERNIA

At this stage, in the arsenal of physicians and parents - massage and gymnastics. Yes, yes, exactly the one! .. Changing the baby's diapers, mommy can massage the umbilical ring, first clockwise, then counterclockwise. It is the umbilical ring that should be massaged, and not the entire tummy, otherwise the baby's digestion can be disturbed.

And when the baby begins to hold the head, it can and should be laid out on the tummy. All the babies are laid out on the tummy, but if your baby has an umbilical hernia, make sure that the surface on which he is to lie is firm. Such simple exercises strengthen the muscles of a small tummy and can contribute to self-tightening of the umbilical ring.

Taping, massage and laying on the tummy are conservative methods of treatment. Surgeons try not to resort to anesthesia and a scalpel until the baby is 3-5 years old, because any operation is stressful for the child's body. And yet, the main indication for surgical intervention is not the age of the baby, but the condition of the umbilical hernia.

If a hernia causes concern, causes discomfort to the child, or there is a risk of complications, they can be operated on at the tender age of 3–6 months. If the hernia is small, does not prevent the child from growing and developing, it is likely that it will disappear on its own. You can watch the hernia for a long time. But if by the age of 5 there is no progress towards “self-liquidation”, the child will have an operation, and here is why: in children, infringement of a hernia is rare, but in adults it is much more common. If you do not treat and operate on a hernia, forget about it, for example, until adulthood, then this can turn into a serious plastic surgery in adulthood. For children, it is somewhat easier to operate a hernia.

It remains to be added that there are no general schemes in the treatment of any disease, including umbilical hernia. Only an observing specialist can tell how often a mother should bring her baby for examination to a surgeon. He, based on his observations, decides when to operate on an umbilical hernia and whether an operation is needed at all.

White line of the abdomen(linea alba abdominis). It is formed by intersecting tendon bundles of six broad abdominal muscles (three on the right and three on the left side). The white line separates both rectus muscles, and its direction corresponds to the midline of the body.

The white line stretches from the xiphoid process to the symphysis, and above the navel it looks like a strip, the width of which increases towards the navel. At the top (at the level of the xiphoid process) it has a width of 5-8 mm, in the middle of the distance between the xiphoid process and the navel - 1.5 cm, and at the level of the navel - 2.0-2.5 cm (sometimes more). Below it narrows, but becomes thicker. At a distance of 3-5 cm down from the navel, the white line has a width of 2-3 mm. Near the pubis, it is entirely located in front of the rectus abdominis muscles, so that both muscles in this place are in contact, being separated by a thin fascial bridge.

In the white line of the abdomen there are through (penetrating through its entire thickness to the peritoneum) slit-like spaces. Vessels and nerves or adipose tissue pass through them, connecting the preperitoneal tissue with the subcutaneous tissue. These gaps can serve as an exit site for hernias, called white line hernias.

Navel. In its position, it almost corresponds to the middle of the distance between the tip of the xiphoid process and the upper edge of the symphysis. In most cases, the position of the navel corresponds to the level of the intervertebral disc that separates the III lumbar vertebra from the IV, or the body of the IV lumbar vertebra.

The navel is a retracted scar formed at the site of the umbilical ring. This ring is understood as an opening bordered by aponeurotic fibers of the white line of the abdomen. Three vessels and the urinary duct pass through the opening during fetal development: two umbilical arteries and the urinary duct (urachus) are located along the lower semicircle of the ring, and the umbilical vein is located on the upper semicircle. In the future, these formations become empty and turn into ligaments: urachus - into the median umbilical ligament, umbilical arteries - into the lateral umbilical ligaments, and the umbilical vein - into the round ligament of the liver.

After the umbilical cord falls off, the umbilical ring is tightened with scar tissue (the so-called umbilical scar). At the same time, in the lower half of the ring, the umbilical scar, which is closely fused with three of the mentioned ligaments, appears to be much denser than in its upper half, where the scar remains more pliable.

The layers that form the umbilicus consist of thin skin fused with scar tissue, the umbilical fascia, and the peritoneum. There is no subcutaneous or preperitoneal tissue.

umbilical fascia, which is part of the intra-abdominal fascia, consists of transverse fibers and fuses with the peritoneum as well as with the sheaths of the rectus muscles. In some cases, this fascia covers the entire umbilical ring, in others it does not close at all, ending above the ring. Often the fascia is poorly developed. In accordance with this, the strength of the layers at the site of the umbilical ring is different. The umbilical vein runs in the so-called umbilical canal; in front it is limited by a white line, behind - the umbilical fascia. The lower opening of the canal is located at the upper edge of the umbilical ring, the upper one is 4-6 cm above it. The umbilical ring may be the exit site for umbilical hernias (herniae umbilicales).

An umbilical hernia is a pathology in which the intestines and the greater omentum protrude beyond the boundaries of the peritoneum through the umbilical ring. In infants, its appearance is associated with:

• with intrauterine malformations,
• with accumulation of gas
• with poor ligation of the umbilical cord,
• constipation,
• coughing,
• with frequent violent and prolonged crying.

An umbilical hernia in children may also be due to early standing.
Every fifth baby has this surgical pathology. Among premature babies, it occurs in every third.

Symptoms

A hernia in the navel area, as a rule, appears already at the age of one month. A protruding navel is not yet a pathology. This may well be an anatomical feature. She is under the navel. It is caused precisely by the weakness of the umbilical ring.
Favor the development of the pathology of the disease, which reduce muscle tone (hypotrophy, rickets).

The hernia looks like a rounded protrusion in the area of ​​​​the umbilical ring. It can easily be inserted into the abdominal cavity. Often, a hernia is accompanied by a divergence of the rectus abdominis muscles, since the muscles of the anterior abdominal wall are very weak.

Important: If the umbilical ring is too large, then self-healing becomes impossible.

The size of the umbilical ring determines how large the hernial protrusion will be. The doctor determines the size of the ring by probing the abdomen in the navel area. If the child's ring is large, then the hernia will be constantly visible. If the finger of the hand falls into the abdominal cavity, then it is possible to determine the size of the hernia ring using this technique.

Consequences for the child

Many pediatricians note that children with an umbilical hernia show more anxiety. They also respond to weather changes.
The child does not experience pain in this pathology. But it can provoke bloating, which causes significant discomfort. By and large, pathology can be attributed to cosmetic defects.

Treatment

Basically, doctors advise to wait. If the baby develops correctly, he has enough motor activity, he has normal bowel activity, then by the age of 5-7 years, most likely, self-healing will occur. However, it will not be superfluous to perform exercises that strengthen the muscles of the abdominal cavity, as well as to do a special massage.

If a spontaneous cure does not occur, then surgical methods of treatment are used. For boys, surgical intervention is carried out only in case of complaints of pain from the patient. Girls aged 5-7 years old are operated on, as a hernia may affect the childbearing function in the future. This is possible only in the absence of contraindications.

If the umbilical ring is too large, then self-healing becomes impossible. Such children, as prescribed by a doctor, undergo surgery earlier (at the age of 3-4 years).

Methods of conservative treatment

Parents can independently massage the anterior abdominal wall. It's not difficult at all. It is enough just to stroke the baby's tummy clockwise, and then put it on the stomach for about 5-10 minutes. You need to do the procedure before feeding. Children older than two months are prescribed a massage in a medical facility.

2. Applying an adhesive bandage

How to apply a patch:

• use patches from various companies (Hartmann, Chicco);
• the bandage is applied by the attending physician.

3. Special bandage

The disadvantage of this method is the constant slipping of the bandage.

Surgery

The operation lasts for 15-20 minutes. General anesthesia is used. Rehabilitation takes no more than two weeks. After the operation, there is a ban on physical activity for a month. If the patient's age is less than 4 years, then he stays in the hospital with his mother.