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UMBILICAL CORD HERNIA |
This is a ventral wall defect in which the bowel usually herniates into the base of a normally inserted umbilical cord through a patent umbilical ring.
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- Umbilical cord hernia has similar morphological features to omphalocele and both terms have been used interchangeable in perinatal literature.
- Some authors have described it as a small omphalocele (1) while other workers (2) have used the term "transient omphalocele" to describe a sliding umbilical cord hernia.
- The umbilical cord hernia is thought to result later in embryogenesis, after completion of the normal formation of the primitive umbilical ring by the four body folds at 3 weeks, and normal elongation of the intestine into the umbilical celom at about 5 weeks. During weeks 10-12 when the intestine normally returns to the peritoneal cavity, this process is interrupted, leaving the intestines in the umbilical cord celom, covered by amnion and chorion (3).
- Differentiation of umbilical hernia from omphalocele.
- Morphology of the umbilical ring.
- normal insertion of the cord into the umbilical ring with intact skin covering the ring in umbilical hernia. Rectus muscles have a normal midline insertion close to the xiphoid.
- large defect in the umbilical ring involving the adjacent muscles and skin in omphalocele.
- Contents within the defect.
- intestines that protrude into the base of the ring in umbilical hernia.
- intestines, liver and other abdominal viscera may be contained in the omphalocele.
- Associated Anomalies.
- Rare, except for malrotation and volvulus (1).
- Table comparing omphalocele, gastroschisis
and physiological hernia.
REFERENCES |
- Knochel JQ, Lee TG, Melemdez MG, Henderson SH. Fetal anomalies involving the thorax and abdomen. Radiol Clin North Am 1982;20:297-310.
- Bromley B, Benacerraf BR. Transient omphalocele. J Ultrasound Med 1992;12:688-689.
- Achiron R, Soriano D, Lipitz S et.al. Fetal midgut herniation into the umbilical cord: improved definition of ventral abdominal anomaly with the use of transvaginal ultrasound. Ultrasound Obstet Gynecol 1995;6:256-260.