At a glance: Central umbilical hernia vs paraumbilical hernia

Paraumbilical hernia is more common in adults than children
Paraumbilical hernia is more common in adults than children

Central umbilical hernia
Clinical features

  • Occurs following failed fusion of the anterior abdominal wall after birth.
  • Often evident a few days after delivery.
  • The hernias are usually small.
  • The underlying defect is usually smaller than the visible hernia.
  • A cough reflex is present. 

Management

  • Most settle spontaneously and parents can be reassured.
  • Surgeons are usually unhappy to operate before one year old.
  • Strangulation never occurs in central hernias.

Paraumbilical hernia
Clinical features

  • Occur as a central swelling usually above or below the umbilicus.
  • These hernias may become very large.
  • More common in adults (especially women), than children.
  • May be associated with obesity and weak abdominal muscles.
  • The sac may contain both bowel and omentum.
  • This is a true defect in the linea alba close to the umbilicus. 

Management

  • These hernias will not resolve without surgical intervention.
  • The patient should be advised to lose weight.
  • Surgical repair is recommended because of strangulation risk. 

Contributed by Dr Nigel Stollery, a GP in Kibworth, Leicestershire and a clinical assistant in dermatology at Leicester Royal Infirmary

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