Umbilical hernia

　　Umbilical hernia is caused by a pause in the process of closing the embryonic body cavity during embryonic development. Some scholars believe that the disease has a familial tendency. In addition to the intestines, large umbilical hernia sacs may also contain liver, kidney, spleen, bladder, and other organs. Umbilical hernia often occurs with malformations of the cardiovascular, digestive, urinary, musculoskeletal, and central nervous systems.

　　Disorders in blood supply to the umbilical hernia sac wall and rupture can lead to abdominal organ prolapse and secondary abdominal infection, which can be life-threatening in severe cases. If the child undergoes surgery in time, attention should be paid to the prevention and treatment of postoperative complications.

　　1. Respiratory disorders:Due to the upward push of the diaphragm, it causes difficulty in breathing, leading to cyanosis, and even death.

　　2. Circulatory disorders:Increased intra-abdominal pressure compresses the inferior vena cava and portal vein, causing their return to be obstructed, leading to circulatory failure and lower limb edema.

　　3. Intestinal obstruction:Compression of the stomach and small intestine can lead to intestinal obstruction, necrosis, or perforation.

　　4. Incision rupture:The tension of the incision is too great, it is easy to tear open, and it can cause visceral prolapse again.

　　The umbilical hernia can be divided into giant umbilical hernia and small umbilical hernia, the symptoms are as follows:

　　1. Giant umbilical hernia

　　The diameter of the abdominal wall defect ring exceeds 5cm, sometimes more than 10cm, and the diameter of the protruding part is often even larger, protruding centrally like a steamed bun-like mass, with the umbilical cord connected to the top of the sac membrane. After birth, the organs inside the sac can be seen through the amniotic membrane. The contents of the sac, in addition to the small intestine and colon, also include liver, spleen, pancreas, and even bladder. 6 to 8 hours after birth, due to insufficient blood supply to the sac wall and exposure to the air, the sac membrane becomes turbid and edematous, the membrane thickens, and becomes dry and fragile in 2 to 3 days, easy to break, and even necrotic. The rupture of the sac wall can lead to peritoneal infection and prolapse of internal organs in the sac, and in severe cases, it can cause the death of the child. Therefore, it should be treated in time in the early stage. About 1% of children have sac membrane rupture before or during labor, leading to prolapse of internal organs. Once the sac membrane ruptures in the uterus, the prolapsed organs, due to long-term immersion in amniotic fluid, the bowel wall becomes edematous and thickened, without luster on the surface, and covered with inflammatory exudates. There are many meconium-colored cellulose on the surface, secondary peritoneal infection occurs, and the mortality is extremely high. If the sac membrane ruptures during delivery, the color of the internal organs and bowel is bright red, without yellow纤维素 covering, and the child can be saved after emergency treatment. Although the time of sac membrane rupture is different, residual sac membranes can be found, and the skin at the base of the sac membrane can crawl along the surface of the sac membrane, finally forming connective tissue under the scab to cover the surface of the sac membrane. The junction between the skin and the sac membrane is prone to infection, which can spread to the peritoneum.

　　2. Small umbilical hernia

　　The diameter of the abdominal wall defect ring is less than 5cm, protruding centrally like an orange, even an olive-like mass. Because the diameter of the protruding part is often larger than the abdominal wall defect ring, it can form a pedunculated mass in the central abdomen, and the contents of the sac are mostly small intestine, and sometimes transverse colon. During delivery, if the umbilicus is found to be enlarged, it should be ligated above the umbilical cord to prevent the bowel from being ligated in it, causing bowel necrosis.

　　Umbilical hernia is the most common congenital abdominal wall developmental malformation, with an incidence rate of 1/5000-1/10000, mostly in males. The etiology is not yet clear, and some scholars believe that the disease has a familial tendency. The main preventive measures for this disease are:

　　1. Do not eat too much salty and spicy food, do not eat overheated, cold, expired, or deteriorated food;

　　2. People with certain disease genetic factors should eat some alkaline foods with high alkali content in moderation, maintain a good mental state;

　　3. Regular abdominal ultrasound during pregnancy can detect umbilical hernia early, so that treatment can be taken immediately after childbirth.

　　Umbilical hernia symptoms are obvious, no special examination is required. However, preoperative X-ray chest fluoroscopy, gastrointestinal ultrasound, and other examinations should be performed to understand the presence of associated malformations and other complications, so that they can be dealt with at the same time during surgery.

　　Children with umbilical hernia after surgery should choose foods rich in high-quality protein, such as milk and dairy products (older children should choose skimmed fresh milk or milk powder), eggs, soybean powder, animal liver and kidney, lean meat, fish, chicken meat, yogurt, etc., in 6 meals a day.

　　Children with umbilical hernia should undergo surgery as soon as possible, regardless of the size of the hernia. If the surgery can be completed within 6 hours after birth, not only can the risk of infection and sac membrane rupture be reduced, but also since there is no food in the gastrointestinal tract and little gas, it is conducive to the repositioning of the prolapsed organs into the abdominal cavity for repair, which can reduce the mortality rate.

　　1. Surgical treatment

　　1. Indications

　　(1) Regardless of the size of the umbilical hernia, emergency surgery should be performed for cases with sac membrane rupture. During the operation, the intestinal malformation should be handled properly first, and then the umbilical hernia is treated according to the principle of sac membrane rupture;

　　(2) Small umbilical hernia, the base diameter is less than 5cm, the sac only contains intestines, without liver, and the prolapsed organ does not cause respiratory and circulatory dysfunction after it is returned to the abdominal cavity;

　　(3) The base of the sac membrane is pedunculated, and the prolapsed organ is prone to torsion, causing obstruction or incarcerated.

　　(4) Cases with intestinal atresia, intestinal stenosis, malrotation, etc., leading to intestinal obstruction.

　　2. Preoperative preparation

　　Children with umbilical hernia due to a large amniotic sac or intestine exposed directly to the outside often lose heat quickly, leading to hypothermia; body fluids can also be lost rapidly, leading to water and electrolyte imbalance; due to contamination, it is easy to develop infection and sepsis. Therefore, before surgery, it is important to focus on temperature management, infection prevention, and correction of water and electrolyte balance.

　　(1) Covering the amnion: immediately cover the amnion or prolapsed intestine with sterile warm saline antibiotic gauze after the child is born, wrap it with dry gauze on the outside, cover it with a layer of plastic film on the dressing, or place the child's body in a plastic bag to prevent evaporation of water and loss of heat. For children with prolapsed intestine, the intestine should be lifted away from the abdominal wall during wrapping, and attention should be paid to prevent twisting and strangulation of the intestine.

　　For cases with late medical treatment, accompanied by low body temperature, amniotic or organ contamination, warm normal saline antibiotic solution should be used for repeated flushing first to gradually restore body temperature, and at the same time, it can clear the contamination on the surface of the organs, which is very effective in preventing metabolic disorders caused by hypothermia and sepsis caused by peritonitis.

　　(2) Gastric tube decompression: insert a gastric tube and frequently aspirate to prevent vomiting and reduce gastrointestinal gas. The case should be referred to surgery promptly.

　　(3) Rapid fluid replacement: correct the imbalance of water and electrolytes, and give 20 to 40ml of plasma, 50mg/kg of gamma globulin. At the same time, broad-spectrum antibiotics, vitamin K, oxygen therapy, etc., should be administered.

　　All the above measures, including the necessary examinations for the children, should be completed within 1 to 2 hours to ensure that surgery can be performed as soon as possible.

　　3. Surgical methods

　　Surgery includes three types: one-stage repair, two-stage repair, and staged reconstruction repair. The surgical steps are divided into three steps, namely, visceral repositioning, excision of the hernia sac, and repair of the abdominal wall.

　　Non-surgical therapy

　　In the past, it was believed that surgery was the only method to save the lives of children with diseases, but the mortality rate was high. In recent years, some people have adopted different treatment methods according to the specific conditions of the children, that is, surgical treatment is still adopted for children who seek medical treatment early. However, for those children who seek medical treatment late, have poor general condition, and have local infection, non-surgical therapy is adopted and good results are obtained.

　　1. Treatment Mechanism

　　Non-surgical therapy involves applying an antiseptic agent to the surface of the囊膜 to dry and form a scab, under which granulation tissue grows. Then, epithelial cells grow from the peripheral skin margin towards the surface of the granulation tissue, and the囊膜 is covered by epithelial cells and connective tissue, forming a form similar to an external hernia. Subsequently, an appropriate time is chosen to repair the external hernia.

　　2. Indications

　　(1) Umbilical hernia with intact囊膜 of different sizes, especially premature infants with other serious malformations or complications that are not suitable for surgery, such as ectopia vesicae, severe heart disease, multiple malformations, etc.;

　　(2) Large umbilical hernia with intact囊膜, the protruding viscera cannot be returned to the abdominal cavity, and there is no condition for staged surgical repair;

　　(3) Children are seen after 3-4 days of birth, and the amniotic membrane surface has already been infected.

　　3. Common Antiseptic Agents

　　Children can be treated with benzylamine (zephiran), 0.5% silver nitrate solution, 1% iodine tincture, or 0.5% merbromin mixed with 65% ethanol, as merbromin can cause systemic poisoning after absorption, and it is rarely used in recent years.

　　4. Operation Method

　　Appropriate antiseptic agents should be applied to the囊膜 and its surrounding area, the囊膜 should be wiped 1-2 times a day to keep the area dry, and sterile gauze should be covered after each wipe, and elastic bandage should be wrapped externally. Because ethanol and silver nitrate have bactericidal, protein coagulation, and astringent effects, the囊膜 usually presents as a dry scab within 1-2 days, and a thick scab will form on the entire囊膜 after 1 week. The dry scab will gradually fall off, and granulation tissue will grow on the wound surface, while the surrounding epithelial tissue will gradually grow towards the center. Generally, within 2-3 months, the skin can cover the entire囊膜. Due to the contraction of scars, the intestinal tract gradually re-enters the abdominal cavity, and during this process, as the child grows and develops, the volume of the abdominal cavity gradually expands, and organs protruding outside the body, such as the liver and intestines, will slowly return to the abdominal cavity. Surgery to repair the abdominal wall should be performed after 1-2 years of age.

　　Non-surgical therapies do not require special equipment and technology, the methods are simple and easy to perform, and the effects are reliable. However, there are also drawbacks: it cannot detect other associated malformations in the abdomen; the healing and covering of the囊膜 with epithelial cells and scar tissue requires a longer treatment time; there is often extensive adhesion between the intestinal tract and scar tissue, making the repair surgery more difficult.