Umbilical hernia in pediatric patients attending outpatient department in tertiary care centre

INTRODUCTION

The term “umbilical hernia” refers to a protrusion at the location of the umbilicus and a corresponding fascial deficiency. The anterior abdominal wall is frequently affected in pediatric patients. It develops as a result of the umbilical ring's inability to completely close or being incompletely closed, leaving a gap through which the contents of the abdomen may protrude.¹

The fetal primitive umbilical ring can be seen on the ventral surface of the body as early as the fourth week of pregnancy. It has loop of midgut, allantois, vitelline duct, vitelline vessels, and umbilical vessels (one vein and two arteries). After birth, the umbilical veins disappear and are replaced by a ligamentous tissue. Umbilical hernia will be more likely to develop if the umbilical ring is not completely removed after the umbilical cord has been separated. A relatively weak spot in the abdominal wall that is vulnerable to herniation as a result of elevated intra-abdominal pressure is the umbilicus.²

According to estimates, 15% of children have umbilical hernias. It varies based on factors like age, race, gestational age, and concurrent diseases. Blacks, premature, low birth weight, syndromic infants, kids with connective tissue diseases, and kids with pathologies that increase intra-abdominal pressure all have higher rates of them than the general population.^3-5

In majority of cases the umbilical hernias (approximately 90%) close naturally as the child will attain the age of 4-5 years. A helpful sign for spontaneous closure is the size of the hernial ring. Surgical repair may be advised before the child is 4-5 years old in the event of a significant hernia or incarceration.⁶

Thus, the present study was undertaken to determine the prevalence and to assess the risk factors of umbilical hernia in paediatric patients attending OPD in tertiary care Centre.

METHODS

The present observational study was conducted in pediatric outpatient department, in Acharya Shri Chander College of Medical Sciences (ASCOMS), w.e.f. 1st April 2023 to 31st March 2024 after obtaining ethical clearance from the Institutional Ethical Committee (IEC), vide number ASCOMS/IEC/2023/Meeting-I/26. A total of 100 study subjects with suspected umbilical hernia were included in the study after obtaining the informed consent from parents / guardians.

Inclusion criteria

Patients with <18 years age group and patients suspected with umbilical hernia.

Exclusion criteria

Study subjects whose parents/guardian refused to participate in the study and with comorbid illnesses.

A detailed history including family history and gestational history of mother was collected and thorough clinical examination was performed for all the patients. The data was collected with the help of a structured clinical proforma.

The collected data was recorded in Microsoft Excel sheet and analysed with SPSS version 20.0.

RESULTS

The majority of the study subjects were in the age group of 0-1 year (30%) followed by 2-4 years (24%), 8-10 years (20%), 5-7 years (19%), 11-13 years (6%) and >13 years (1%) as depicted in Table 1. Also, most of the subjects were males (57%).

Table 2 depicted that the observed risk factor in the development of umbilical hernia were low birth weight (81%), premature delivery (54.54%) and undernutrition (90.9%). No case was reported with complicated umbilical hernia.

Table 3 depicted the anthropometric profile of study subjects. The mean birth weight of study subjects was 1.9±0.47 kg, mean weight at the day of OPD visit was 9.87±9.81 kg and mean height of study subjects at the time of visit was 89.19±19.22 cm.

Table 4 showed the nutritional status of study subjects at the time of OPD visit. In our study most of the study subjects were underweight (51%), 39% had normal weight and 10% were overweight.

The clinical manifestations of study subjects at the time of OPD visit is depicted in Figure 1. It was observed that most of the subjects had loss of appetite (39%) followed by fever (31%), abdominal pain (29%) and vomiting (9%).

The present study observed that the overall prevalence of umbilical hernia was 11%, among them most of the common involved age group was 0-1 year (6%) followed by 8-10 (3%) years and 2-4 years (2%) as depicted in Table 5. The development of umbilical hernia was commonly seen in males (64%) as depicted in Figure 2.

DISCUSSION

Umbilical hernia develops as a result of the umbilical ring's inability to completely close or being incompletely closed, leaving a gap through which the contents of the abdomen may protrude. The anterior abdominal wall is frequently affected in pediatric patients.

In our study umbilical hernias were 11% common overall, with the most prevalent age group involved being 0-1 year (6%) followed by 8-10 years (3%) and 2-4 years (2%). In 64% of males, umbilical hernia was observed. These findings are consistent with the study conducted by Lassaletta et al and Burcharth et al, found that the prevalence of umbilical hernia among children was 10-30%.^7,8 Low birth weight (81%), early delivery (54.54%), and undernutrition (90.9%) were the risk factors for the development of umbilical hernia that were detected. There were no cases of complicated umbilical hernias recorded. In similar study done by Evans et al found that the common associated factors with development of umbilical hernia was premature delivery and low birth weight.⁹

The majority of the study subjects were in the age group of 0-1 year (30%), male to female ratio was 1.32:1. The mean birth weight of study subjects was 1.9±0.47 kg, mean weight at the day of OPD visit was 9.87±9.81 kg and mean height of study subjects at the time of visit was 89.19±19.22 cm. These results are similar to the study performed by Ahmed observed that the most of the study subjects were in the age group of 0-23 month (47.8%) and majority of the subjects were males. The average birth weight in their study was 3.10±0.47 kg, average weight at admission was 13.66±9.83 kg and the average height was 91.89±20.34 cm.¹⁰

Limitations

Small sample size used in our study. The study doesn’t not include the effect of altered thyroid profile resulting in umbilical hernia. Study duration could have been longer to have a better idea of prevalence of umbilical hernia in the community.

CONCLUSION

The present study concluded that the prevalence of umbilical hernia in pediatric patients attending OPD is 11% and the most common risk factors in the development of umbilical hernia among pediatric population are undernutrition, low birth weight and prematurity.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

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9. 9. Evans AG. The Comparative Incidence of Umbilical Hernias in Colored and White Infants. J Natl Med Assoc. 1941;33(4):158-60.
10. 10. Ahmed IH. Prevalence and risk factors for incarceration in children managed for umbilical hernia at Kenyatta National Hospital. Master of Medicine in Paediatric Surgery Thesis. University of Nairobi. 2021. Available at: http://erepository.uonbi.ac.ke/bitstream/handle/11295/160697/Ismail_Prevalence%20and%20Risk%20Factors%20for%20Incarceration%20in%20Children%20Managed%20for%20Umbilical%20Hernias%20at%20Kenyatta%20National%20Hospital.pdf?sequence=1. Accessed on 01 April 2024.