Pictorial Case Study

THE CASE

A six-week-old baby boy was brought by his mother for his routine check. Examination was entirely normal except that a small, soft, spherical lump was noted at the umbilicus. On gentle palpation this lump disappeared. He was otherwise well and thriving.

What is the diagnosis, management and differential diagnosis?

DIAGNOSIS AND MANAGEMENT

The diagnosis is an umbilical hernia which occurs due to a weak section of abdominal wall muscle allowing the bowel to protrude near the umbilicus. It may occur in up to one in three babies and is more common in premature babies and in males than in females.

Most umbilical herniae - 90 per cent - occur in babies of African Caribbean origin and only 10 per cent in babies of Caucasian origin. There is often history of another family member who has had an umbilical hernia.

Although the hernia looks uncomfortable, it is painless. Almost all are easily reducible and require no immediate treatment because they resolve by the age of 12 months. Explanation of the hernia and reassurance is all that is required.

Arrange to review the hernia at six months and by that time it might have resolved completely.

If the hernia persists after the age of two or three and there is a risk of strangulation refer for surgery.

POSSIBLE DIFFERENT DIAGNOSES
- Umbilical granuloma.
- Variant of normal of appearance of the umbilicus.

DIFFERENTIAL DIAGNOSIS
Umbilical granuloma
- Common.
- Red, friable and moist remnant of granulation tissue.
- May need treatment with silver nitrate.
- Sometimes it is linked with patent uracha.

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