How Do Abdominal Wall Anomalies Form?

In the womb, the abdominal wall of the fetus is formed by 4 folds consisting of cephalic, caudal and 2 lateral folds. The anterior abdominal wall develops from the somatic part of these folds and the internal organs develop from the splanchnic layer.

Cephalic fold: This fold extending forward contains the foregut and forms the pharynx, esophagus and stomach. The somatic layer forms the thorax, epigastrium wall and primitive diaphragm. If the cephalic fold develops incorrectly, epigastric omphalocele occurs and is found together with cleft sternum, diaphragmatic defect, pericardial defect and cardiac anomalies, this syndrome is called Cantrel Pentalogy.

Caudal fold: The caudal fold, which extends posteriorly and is smaller, forms the hindgut and allantois. The colon and rectum develop from the hindgut. The splanchnic layer covers the anterior surface of the hindgut. The somatic layer forms the allantois, bladder and hypogastric abdominal wall. If the caudal fold develops incorrectly, hypogastric omphalocele, hindgut agenesis (anal atresia) and bladder exstrophy occur.

Lateral folds: Together with the splanchnic and somatic layers, they form the lateral abdominal walls and the umbilical ring. In the event of a developmental error at the end of the 3rd week of the lateral folds, the umbilical ring remains open and omphalocele or umbilical cord hernia occurs as a result. In omphalocele and gastroschisis, the muscular development of the anterior abdominal wall is normal. If there is no developmental defect, all folds progress towards the umbilical ring in the 12th week, with the intestines returning into the abdomen, and form the umbilical ring in a way that allows physiological herniation. In the intrauterine period, within the umbilical ring; There are omphalomesenteric duct, urachal duct, umbilical vein, and umbilical arteries.

What are the Pathologies of the Anterior Abdominal Wall?

In summary, the pathologies that will develop due to developmental errors of the anterior abdominal wall are as follows;

• Omphalocele
• Gastroschisis
• Omphalomesenteric canal anomalies
• Epigastric hernia
• Diastesis recti
• Paraumblical hernia
• Umblic hernia
• Lateral hernias
• Spigiel hernia
• Inguinal hernias
• Urachal anomalies
• Congenital pubic sinus
• Bladder exstrophy
• Cloacal anomaly

Our article will not include pathologies that will be evaluated specifically. Those topics will be evaluated under separate headings.

What is Epigastric Hernia in Children?

Epigastric hernia in children is a small opening on the anterior abdominal wall and the fascia we call linea alba, which provides abdominal integrity in the middle line. The incidence is around 5%, the opening is around 1 cm. They are located between the navel and the chest and in the midline. It becomes apparent during straining, coughing and excessive physical activity. It can usually be single, sometimes multiple. It does not close spontaneously.

How is Epigastric Hernia Diagnosed in Children?

Diagnosis is made by history and physical examination. Ultrasonography may rarely be required. Preperitoneal fat tissue usually enters the defect and this tissue is palpable as a swelling of 0.5-1 cm in diameter. Sometimes the defect may be empty and becomes apparent when the child strains. It may cause abdominal pain due to retraction of the peritoneum or omental compression. During surgery, small lipomas with a stalk are usually palpable on the fascial defect. However, since these lipomas can sometimes leak inward, it may be difficult to determine the location of the fascial defect, so the location must be marked before surgery.

Does Epigastric Hernia Close on Its Own, What Kind of Complaints Does It Cause?

They do not tend to close on their own, and they can also cause abdominal pain, so they should be closed with surgery. Treatment options vary depending on the child's age and the size of the problem. A process like the umbilical hernia closing over the years is not expected in epigastric hernia. If the opening is very small, it may become less obvious as the child grows. Serious complications are rare. Fatty tissue can get stuck in small hernias, causing redness and pain. In rare cases, the intestine can get stuck in the large opening, and in such a case, emergency surgery is required.

When is Epigastric Hernia Surgery Performed in Children?

In cases where there is no problem, the most appropriate age for surgery is around 1-1.5 years. The opening is very small, so marking should definitely be done with the family on the morning of the surgery,

How is Epigastric Hernia Surgery Performed in Children?

The surgery is planned and performed as a day surgery. The fatty tissue is pushed in or excised with a small incision made from the swelling area. The open fascia edges are found and closed with stitches. Your child starts taking liquid foods after fully waking up after the surgery. They are usually discharged the same day, but in some cases they may stay in the hospital for 1 day. Oral painkillers are sufficient.

The bandages are removed after 2-3 days and the wound is left open. They can take a bath after an average of 4-5 days. It is necessary to stay away from heavy activities and sports for 2-3 weeks.

If there is redness, swelling, pain or fever at the wound site, you should see a doctor again. Wound infection is a rare but most important complication.

Does Epigastric Hernia Reoccur?

The risk of recurrence is close to zero when done properly.

What is Paraumbilical Hernia?

It is a hernia located slightly above the navel and very close to the navel. Sometimes it can be together with an umbilical hernia. Its difference from an umbilical hernia is that the hernia sac is not attached under the skin. Therefore, it is sufficient to close only the fascia defect. It is not likely to disappear on its own, therefore, it is appropriate to perform an operation after the diagnosis is made. However, since it is very close to the umbilical ring, it can be confused with an umbilical hernia, care should be taken.

The diagnosis, treatment and surgery of the disease are like Epigastric hernia.

 

 

What is Umbilical Hernia?

It is a hernia that develops due to the failure of the fascia surrounding the exit point of the umbilical cord and providing its strength to close. The peritoneum and small intestine herniate. The hernia opening can be from a few millimeters to 3-4 cm. As the opening grows, the probability of closure decreases. It is observed in 25-50% of children. It is seen equally in girls and boys, and there is a high familial predisposition. It is more common in premature and low birth weight babies. In most babies, the defective fascia ring usually closes spontaneously within the first 2 years of age. Defects wider than 2 cm after the age of 2 and all defects over the age of 4 should be closed surgically. The risk of strangulation of an umbilical hernia is quite low.

 

How is Umbilical Hernia Diagnosed?

There is a temporary swelling in the belly with crying and straining. It disappears on its own when the baby relaxes. A definitive diagnosis is made with ultrasonography when necessary.

What are the Treatment Principles of Umbilical Hernia?

90% of them usually resolve on their own without requiring treatment until the age of 3. If they do not resolve, they are corrected with surgery, as in daily epigastric hernia.

When Should Umbilical Hernia Be Surgery?

• If it has not resolved by the age of 3 in girls and by the age of 4 in boys
• If strangulation has occurred even once

How is the surgery performed?

Surgical treatment is performed by finding and excising the hernia sac with a crescent-shaped incision made under the navel, and then closing the healthy fascia tissue with absorbable stitches. The surgery can also be performed laparoscopically, but it has no advantage over open surgery.

What Should Be Done Until Umbilical Hernia Closes in Children or Until the Age of Surgery?

There is no need for treatment in babies with umbilical hernias during the first two years of life. Even if the swelling outside the hernia grows over time, it will most likely heal on its own with the development of the abdominal wall. Especially defects smaller than 1 cm in diameter are more likely to close on their own and earlier.

Is It Necessary to Tie a Band to the Umbilical Cord in Umbilical Hernias?

Methods such as sticking a coin to the umbilical cord or tying an umbilical cord do not increase the likelihood of healing and may cause harm such as skin necrosis and allergy to the plaster, so they should not be applied.

What is Diastasis Recti?

It is a thin and long herniation that occurs when straining or changing from lying down to sitting position due to weakness of the linea alba between the two rectus muscles, especially in the area above the navel. It does not cause a clinical problem, surgical treatment is mostly for cosmetic reasons.

 

What is Lumbar Hernia?

There is a bulge formed by preperitoneal fat tissue that bulges out from two potential defects in the abdomen. Strangulation of the hernia is quite rare, if the patient has complaints, it should be treated.

What is Spigelian Hernia?

These are hernias that occur as a result of weakness in the muscles and fascia that occur in the anterior abdominal wall, slightly below the navel and slightly lateral to it (semiulnar line). It is more common in girls and on the right side. It can be difficult to diagnose. During physical examination, a sensitive mass is felt below and lateral to the navel. Although the hernia sac is large, the defect is actually very small. There is a risk of strangulation of the hernia in 20% of cases. Therefore, surgery is necessary after the diagnosis is confirmed with physical examination, ultrasonography and computerized tomography. The defect is closed after the sac neck is found.

*** The information provided here and the content of the website are arranged for the purpose of informing visitors, especially families. No information should be considered as advice by visitors and should not lead to any decision or action. The patient should definitely be examined by a pediatric surgeon on the subject, and a decision should be made by consulting him/her and consulting his/her personal knowledge.