Cord Hernia Research Articles

In-utero, incarcerated umbilical hernia with fistula

Abstract Omphalocele, gastroschisis, and umbilical hernia are abdominal wall defects well-characterized by their clinical presentation, umbilical cord position, treatment options, and clinical course. Differentiating omphalocele from umbilical cord hernia can be challenging. To our knowledge this is the first case of an incarcerated umbilical hernia with a fistula that may have originated in-utero.

Hernia of the umbilical cord: a clinical spectrum

Background: Hernia of the umbilical cord is a rare clinical entity which presents with hernia of the small bowel into the proximal part of the umbilical cord. This is sporadically associated with other congenital malformations. This is usually poorly identified and mistakenly termed as ‘omphalocele minor. Inadvertent clamping of the cord in these cases leads to iatrogenic bowel wall injury. The aim of this study is to present a spectrum of cases presenting with umbilical cord hernia in a tertiary care Govt medical college, along with demography, intra operative findings, associated malformations and postoperative outcome and 1 year follow up.Methods: This is an ambispective study on neonates who attended the Outpatient Department (OPD) or Emergency department. The babies were evaluated by age, birth weight, gender, any gross clinical malformation. They were also evaluated intraoperatively for any associated anomalies. Post-surgery the babies were followed up until 2 years of age in pediatric surgery OPD of the same institute and outcome was recorded.Results: Out of 90 babies, 88 babies (97.77%) had body weight more than 2.5 kg, and rest 2(2.22%) had bodyweight of 1.5kg and 1.8 kg. Regarding content of contents of umbilical cord hernia, out of 87 patients, 43 patients (49.42%) had ileal loop as, 32 patients (36.78%) had ileum with Meckel’s diverticulum, 6 patients (6.39%) had cecum with appendix.Conclusions: Most of this study cases had ileal loops as content of the hernial sacs, and 36.78% cases had Meckel’s diverticulum associated, which is a remnant of Vitello intestinal duct. Prompt identification of the condition and early intervention and adequate post-natal care are affective to prevent long term morbidity.

Ventral Abdominal Wall Defects.

1. Sara A. Mansfield, MD, MS* 2. Tim Jancelewicz, MD, MA, MS* 1. *Division of Pediatric Surgery, Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN Clinicians should be aware of the strategies for prenatal and postnatal management of infants with omphalocele and gastroschisis. After completing this article, readers should be able to: 1. Recognize the implications and differences in management between gastroschisis and omphalocele. 2. Review the initial stabilization and management of infants with omphalocele and gastroschisis. 3. Review the surgical management options and rationale for infants with ventral abdominal wall defects. Abdominal wall defects represent a wide spectrum of congenital anomalies. These can range from lethal limb-body wall syndrome to benign umbilical cord hernias. Gastroschisis and omphalocele are the 2 most common defects and are the focus of this review. Although both of these diseases affect the umbilical area, they differ widely in their underlying pathogenesis, genetics, and associated disorders. Consequently, their management techniques and outcomes are quite different. This article reviews the pathogenesis, genetics, diagnostics, and outcomes for each disease, followed by an in-depth review of recent management updates. ### Pathogenesis Omphalocele (or exomphalos) is a herniation of the abdominal viscera through a midline abdominal wall defect (Fig 1). This defect is located at the base of the umbilical stalk, and herniated viscera are covered by a 3-layer membrane of peritoneum, Wharton jelly, and amnion. This contrasts with umbilical cord hernias, which are covered by intact skin and contain only a small protrusion of abdominal contents, and gastroschisis, which has no covering at all and occurs to the right of midline (Table). Omphaloceles are present in approximately 1 per 1,100 pregnancies. However, there is a high rate of spontaneous abortion, making the incidence of omphalocele per live birth approximately 1 per 4,000 to 1 per 6,000. (1) …

Application of a borate-containing glass for the treatment of trophic wounds in children, suffering myelodysplasia

Objective. To estimate the possibility of application of a borate-containing glass material while treating trophic wounds in children, suffering myelodysplasia.
 Маterials and methods. The data, concerning 3 children, who, while their newborn time were operated on for a spinal cord hernias, are presented. All the children have had myelodysplastic disordered trophic wound of the lower extremities, causing severe course of the wounds or the bedsores healing. Bioactive borate-containing glass «Mirragen», manufactured in USA, was proposed by medical centre «Меdyvo» for treatment of trophic wounds in children.
 Results. Application of bioactive borate-containing glass while treating trophic wounds in children, suffering myelodysplasia, was effective. Deep wounds during 8 weeks have had healed completely without complications, and a superficial wound—bedsore - during 5 weeks. The wounds have epithelized steadily, starting together from the bottom and periphery with velocity up to 12-15% of their square weekly. Negative general or local reaction towards a borate-containing glass in the patients was absent.
 Conclusion. Тemporary biomaterial, structured by a carcass, made of a borate-containing glass, guarantees a necessary form establishment, needed for creation of a new tissues and promotion of rapid healing of the wounds. Application of a bioactive borate-containing glass constitutes a safe and efficient method of treatment for trophic wounds in children, suffering myelodysplasia.

Pattern of prenatal ultrasound diagnosed anterior abdominal wall defects at the University College Hospital, Ibadan, Nigeria: A pictorial essay

Anterior abdominal wall defects form a wide spectrum of congenital abnormalities that allow the abdominal contents to protrude through an unusual opening on the abdominal wall. These defects could be physiological or pathological depending on the time of diagnosis. They include physiological gut herniation, congenital umbilical cord hernia, omphalocele, gastroschisis, ectopia cordis, bladder exstrophy, body-stalk anomaly, Prune-Belly Syndrome, and pentalogy of Cantrell. Correct prenatal diagnosis of these anomalies with ultrasound (US) is extremely important for patient management. Evaluation of the defect relative to the umbilical cord insertion site is fundamentally important in differentiating among the various malformations. We present a pictorial essay of the spectrum of anterior abdominal wall defects diagnosed prenatally with US seen over a 5-year period at the University College Hospital, Ibadan.

Congenital Umbilical Appendix Misdiagnosed as Umbilical Granuloma: Report of 2 Cases

Background: Umbilical cord hernia is an uncommon umbilical anomaly which develops during 10th to 12th weeks of gestational age owing to failure of complete bowel return into coelomic cavity. In extremely rare cases appendix is the only trapped organ in hernia sac which may erode the overlying membrane and simulate umbili-cal granuloma.
 Case Report: Two infants presented with delayed umbilical cord separation with a reddish mass at umbilicus which was initially diagnosed as umbilical granuloma. Surgical exploration on failure of conservative measures revealed it as vermiform appendix. Appendectomy was done in both cases.
 Conclusion: Vermiform appendix at umbilicus is a rare congenital anomaly and may simulate other pathologies at umbilicus.

Topographic and Anatomical Evaluation of the Effectiveness of Various Methods Reducing the Height of the Inguinal Space Used in Hernioplasty for Inguinal Hernias

Purpose - to evaluate efficiency of different methods reducing height of the inguinal canal with apply in inguinal hernia repair in randomized topographic anatomical study. Material and methods. The randomized topographic anatomical study was performed on 24 unfixed cadavers of male subjects who died at the age of 50.2±6.8 years. The criterion for inclusion in the study was a triangular form of the inguinal canal with a height 2-3 cm. Postoperative cicatrices in the inguinal region, signs of the inguinal hernia and lipoma of the spermatic cord were exclusion criteria. We determined the height of the inguinal canal before and after apply different methods for reducing of this parameter. Results. The dynamic of decrease of the height of the inguinal canal in case apply new method was 30% (from 2.3±0.3 to 1.6±0.2 cm). This result is comparable with the relaxing incision by C. B. MacVay (32%; 2.2±0.4 to 1.5±0.5 cm) and it is larger than the relaxing incisions by R. I. Venglovsky (25%; 2.4±0.2 to 1.8±0.4 cm) and M. M. Ginsberg (14%; 2.2±0.4 to 1.9±0.3 cm). In this case, to apply the performed method compared to relaxing incisions does not destruction of the anterior rectus and appearance of the new hernia portal in the abdominal wall. Conclusion. The developed method of reducing height of the inguinal canal is recommended for approbation in clinical practice because it is effective and safe method.

Fetal anterior abdominal wall defects: prenatal imaging by magnetic resonance imaging.

Abdominal wall defects range from the mild umbilical cord hernia to the highly complex limb-body wall syndrome. The most common defects are gastroschisis and omphalocele, and the rarer ones include the exstrophy complex, pentalogy of Cantrell and limb-body wall syndrome. Although all have a common feature of viscera herniation through a defect in the anterior body wall, their imaging features and, more important, postnatal management, differ widely. Correct diagnosis of each entity is imperative in order to achieve appropriate and accurate prenatal counseling and postnatal management. In this paper, we discuss fetal abdominal wall defects and present diagnostic pearls to aid with diagnosis.

Congenital hernia of the umbilical cord with patent vitello-intestinal duct in a newborn: A rare case

Congenital hernia of the umbilical cord is a less frequent entity in newborns and occasionally associated with other maladies. Sometimes, a large umbilical cord hernia is confused with small omphalocele. We report an unusual case of umbilical cord hernia associated with patent vitello-intestinal duct in a male newborn who underwent surgery and discharged with good general condition.

Sonographic evaluation of testicular hemodynamics after inguinal hernia repair

Objective The aim of this work was color Doppler ultrasound assessment of the effect of inguinal hernia repair on testicular blood flow using open approaches. Background Anatomically, a close relation exists between the spermatic cord and inguinal hernias. Inguinal hernias can carry the risk of ischemia of the testis by intermittent mechanical compression (pressure) on the testicular vessels. The spermatic cord structures may be exposed to invasive surgical intervention during inguinal hernia reconstruction. Surgical dissection, division, or mechanical trauma to the spermatic artery and veins accounts for serious trophic changes in the testis. Patients and methods This study was conducted on 20 patients, suffering from inguinal hernia, admitted to General Surgery Department in Faculty of Medicine, Menoufiya University and the Department of Surgery, Elamria Hospital in Alexandria. All patients were subjected to preoperative evaluation such as history taking, clinical examination, and laboratory investigations. Results This study was designed on 20 patients with primary inguinal hernia (direct and indirect). The age range was between 20 and 50 years. All patients included had primary inguinal hernia. Eight patients had right-sided hernia, whereas 12 patients had left-sided hernia. All the patients were assessed by Doppler ultrasound preoperatively and 3 months postoperatively. Postoperative testicular scan showed no ischemic changes in any patient in our study, and postoperative complications recorded included seroma and mild hematoma. Conclusion Testes are richly supplied by different blood vessels. In the Lichtenstein's hernia repair, there is no significant effect on testicular blood flow.

Umbilical Cord Hernia: Report of an Unusual Case

Congenital umbilical cord hernia is fairly common in infants and it is rarely associated with other anomalies. Sometimes, large umbilical cord hernia is confused with Small omphaloceles. We report an unusual case of umbilical cord hernia associated with patent vitello-intestinal duct (PVID), and Meckel's diverticulum underwent surgery and discharged with good general condition.

Incarcerated umbilical cord hernia containing the gallbladder

Abstract A 16 day-old boy infant with an umbilical mass underwent operative exploration of the umbilicus. The mass proved to be a gallbladder incarcerated in a hernia of the umbilical cord. Distinguishing an omphalocele from an umbilical cord hernia is not obvious and can be arbitrary. Morphologically, the two terms both describe congenital abdominal wall defects covered by a membrane, typically containing abdominal organs. Subtle differences and clinical features between omphalocele and umbilical cord hernia are highlighted in this report.

Idiopathic Spinal Cord Herniation : A Case Report

Idiopathic spinal cord herniation (ISCH) is a rare cause of progressive spinal myelopathy, which frequently presents as Brown-Sequard syndrome. A 50 year old woman consulted for difficulty in walking. On examination, the patient reported sensory deficit of temperature on the left side, associated with diminished anal sensitivity. Nine months before consultation, a walking disorder began disturbing the activities of everyday life. A single case report with surgical treatment outcome. Idiopathic spinal cord herniation is a potentially treatable condition, which should be diagnosed early and treated. The surgical operation contributed clinical improvement in functional autonomy with modification in McCormick classification in our patient. Despite the existence of growing number of ISCH cases in the literature, misdiagnosis and choice of treatment remains a major concern. SCH is a rare clinical entity that seems to be increasing with the accessibility of MRI imaging. Preoperative diagnosis can be made with magnetic resonance imaging (MRI). ISCH should be considered as differential diagnosis of Brown-Sequard syndrome, especially after fourth decade of life. Although progression of neurologic deficits can be gradually slow, reducing surgically the cord hernia and repair of the defect are vital factors in preventing the deterioration and display reversible improvement. In recent reviews, patients who underwent surgery had better outcomes as with our case.

Poorly understood and often miscategorized congenital umbilical cord hernia: an alternative repair method.

Umbilical cord hernia is poorly understood and often miscategorized as "omphalocele minor". Careless clamping of the cord leads to iatrogenic gut injury in the situation of umbilical cord hernia. This study aimed to determine the characteristics and outcomes of umbilical cord hernias. We also highlight an alternative repair method for umbilical cord hernias. We recorded 15 cases of umbilical cord hernias over 10years. The patients' data were retrospectively reviewed, and preoperative preparation of the newborn, gestational age, birth weight, other associated malformations, surgical technique used, enteral nutrition, and length of hospitalization were recorded. This study included 15 neonates with umbilical cord hernias. The mean gestational age at the time of referral was 38.2±2.1 <weeks. Mean birth weight was 3094.3±636.8g. Four infants had associated malformations, including agenesis of the right kidney, left kidney with a duplex system, coarctation of the aorta, ventricular septal defect, meningocele, club foot, and choanal atresia. Surgical exploration was carried out in all of the neonates and they underwent corrective surgery with good outcomes. In an umbilical cord hernia, the body folds develop normally and form the umbilical ring. The double purse-string technique is easy to apply and produces satisfactory cosmetic results in neonates with umbilical cord hernias.

Umbilical cord sparing technique for repair of congenital hernia into the cord and small omphalocele

Background/PurposeCurrent repair of small omphaloceles and hernias into the umbilical cord is a straightforward procedure, whose repair may result in a suboptimal cosmetic outcome. We describe a novel repair technique retaining the umbilical cord elements in an attempt to improve the cosmetic appearance of the umbilicus. MethodsEight neonates were consecutively treated more than a ten-year period. Size of the fascial defects ranged 1 to 3cm (median, 2). Present technique entails incision of the amniotic sac without its detachment from the skin, reduction of the extruded contents under direct vision, and closure of the abdominal wall defect by circumferential suturing of peritoneum and fascia around the base of the amniotic sac. The amniotic sac is then re-approximated and folded to create an umbilical stump, which is trimmed and left to shed naturally. ResultsAll patients achieved a scarless abdomen with a normal appearing umbilicus in 6. The remaining 2 patients are awaiting surgery for persisting umbilical hernia repair and umbilicoplasty, respectively. Poor esthetic outcome was significantly associated with initial fascial defect ≥2.5cm in size (p=0.03). ConclusionsPresent technique is a simple and cosmetically appealing repair for umbilical cord hernias and small omphaloceles, especially effective when the size of the fascial defect is less than 2.5cm. Level of evidenceIV (Treatment Study).

Congenital Hernia of the Umbilical Cord associated with type IIIa Ileal Atresia.

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Posttraumatic both loop ileal prolapse through patent vitello-intestinal duct in a neonate: A rare occurrence

Umbilical cord hernia (UCH) is consisting of 20% of all congenital abdominal wall defects. Vitello-intestinal duct (VID) is the communicating embryonic structure which disappears between the 5 th and 9 th weeks of intrauterine life. Here, we present an interesting case of ruptured UCH with both loop ileal prolapse through patent VID.

Standard values of rapid turnover proteins and zinc in Japanese children.

Measurement of rapid-turnover proteins has an established place in nutrition assessment and is partly dependent on the zinc metallo-enzymes involved. We investigated the reference values of rapid turnover proteins and zinc in Japanese children. This cross-sectional study was conducted at a single center. We collected data from children aged 0 to 12 years with inguinal hernia, umbilical hernia, or hydrocele of the spermatic cord, who had body mass index z scores of -2 to 2. The standard references (mean±2 SD) of transthyretin were 11.5-21.5 mg/dL in infants (<=1.5 years), 13.6-21.5 mg/dL in preschool children (1.6-6 years), and 12.3-23.4 mg/dL in preadolescent children (6.1-12 years). The standard references of retinol binding protein were 1.27-2.55 mg/dL, 1.28-2.54 mg/dL, and 1.27-2.44 mg/dL in each age group, respectively. Rapid turnover proteins did not differ significantly in each group. The transthyretin level was weakly correlated with aging (r=0.284, p=0.003) and estimated lean body mass (r=0.274, p=0.004). Retinol-binding protein was not correlated with aging and anthropometric parameters. We established reference values for rapid turnover proteins with known zinc status in Japanese children. These values were not, or only weakly, correlated with anthropometric parameters for assessing protein energy malnutrition.

Is complete umbilical cord scanning possible at the second-trimester ultrasound scan?

To evaluate the feasibility of umbilical cord scanning during the second-trimester sonographic examination, we looked at the method of scanning, the findings, and the time spent. Five hundred forty-nine singleton pregnancies were evaluated at 18-23 weeks' menstrual age with two-dimensional sonography (US). Color Doppler US was used when needed. The umbilical cord was traced from the fetal insertion site to the placental insertion site. Fetal and placental sites of insertion; number of vessels; presence of knots, cysts, tumors, nuchal cords, or placental anomalies; time spent for scanning; and the use of color Doppler US were noted. The mean maternal age was 33.1 ± 4.1 years, and the mean menstrual age of the fetuses during scanning was 20.4 ± 2.4 weeks. The mean time spent for umbilical cord scanning was 41.5 ± 46.7 seconds. In one case (0.2%), the umbilical cord could not be scanned completely. Color Doppler US was needed in 125 (22.8%) of the scans. Scan results were positive in 153 (27.9%) cases. We observed six cases (1.1%) of a single umbilical artery, two (0.4%) umbilical cord knots, one (0.2%) umbilical cord hernia, and 104 (18.9%) nuchal cords. We also documented 27 (5.0%) marginal insertions, four placenta previa totalis (0.7%), four placenta previa marginalis (0.7%), and eight velamentous insertions (1.5%). Umbilical cord US scanning is feasible during the second trimester of pregnancy, and complete scanning can be performed in the majority of the cases. Color Doppler analysis may aid scanning when needed. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43:249-253, 2015.

Congenital hernia of the umbilical cord associated with extracelomic colonic atresia and perforation of gut in a newborn

Congenital hernia of the umbilical cord (CHUC) is a rare congenital entity compared to more common post-natally occurring umbilical hernia. Although recognized as a distinct entity since 1920s, CHUC is often misdiagnosed as a small omphalocele, resulting in its underreporting. We present the first case report of CHUC associated with extracelomic colonic atresia, complicated by perinatal perforation in a newborn. We also discuss the differentiating features from other anterior abdominal wall defects such as omphalocele and gastroschisis including its embryogenesis.