Umbilical hernia in children

What it is

An umbilical hernia is a defect in the midline with no bowel present. The course files set it beside the two abdominal wall defects it is confused with, and the three are told apart by two things, where the defect is and whether there is a sac:

• Umbilical hernia: defect in the midline, no bowel present; associated with congenital hypothyroidism, which also gives the big tongue
• Omphalocele: defect in the midline, covered by a sac; associated with Edwards and Patau and with Beckwith Wiedemann syndrome, the big baby with the big tongue, neonatal hypoglycemia and ear pits
• Gastroschisis: defect lateral to the midline, usually on the right, with no sac; not usually associated with other disorders; a high maternal AFP is seen; the bowel may be atretic or necrotic and need removal, leaving short gut syndrome

It is also not the paraumbilical or epigastric hernia. The differential given for that one is a lipoma, an abdominal wall hematoma, an abdominal wall tumor such as a sarcoma, and divarication of the recti, and the point to keep in mind is that the epigastric hernia has no cough impulse and is not reducible.