What is the sonographic evaluation of an umbilical (navel) hernia?

From the Guidelines

Ultrasound is the recommended imaging modality for the sonographic evaluation of an umbilical hernia, providing a detailed assessment of hernia contents, size, and potential complications. When performing sonographic evaluation of an umbilical hernia, the patient should be positioned supine with the transducer placed directly over the umbilical region using a high-frequency linear probe (7-12 MHz) for adults and children. The examination should be conducted during both rest and with Valsalva maneuver to assess for hernia reducibility and contents. Key elements to evaluate include the hernia sac size (measuring width of the fascial defect), contents (bowel, omentum, or fluid), and any signs of incarceration or strangulation such as bowel wall thickening, hyperemia, or free fluid.

• The use of color Doppler is essential to assess blood flow within herniated structures, particularly to identify potential strangulation 1.
• The sonographer should document the relationship of the hernia to the umbilical ring and note whether it is reducible during the examination.
• This evaluation helps clinicians determine appropriate management, whether observation, elective repair, or urgent surgical intervention is needed, considering the suitability and timing of surgical repair should be discussed with the patient and a multidisciplinary team involving physicians, surgeons, and anaesthetists 1.
• Ultrasound is particularly advantageous for umbilical hernias due to its accessibility, lack of radiation, real-time imaging capability, and ability to differentiate between true hernias and other umbilical pathologies such as granulomas or umbilical polyps.

From the Research

Sonographic Evaluation of Umbilical Hernia

The sonographic evaluation of an umbilical hernia is not directly addressed in the provided studies. However, some studies provide information on the examination and diagnosis of umbilical hernias:

• The study 2 discusses the use of transvaginal sonography to define ventral abdominal anomalies, including umbilical cord hernia, in fetuses.
• The study 3 explains how to examine the abdomen to diagnose an umbilical hernia, but it does not specifically discuss sonographic evaluation.

Diagnosis and Treatment of Umbilical Hernia

The diagnosis and treatment of umbilical hernias are discussed in several studies:

• The study 4 states that umbilical hernias can be repaired using open, laparoscopic, or robotic approaches, and that mesh should be used to decrease recurrence rates.
• The study 5 recommends mesh reinforcement for umbilical hernia repair, as suture repairs have high recurrence rates.
• The study 6 compares the outcomes of open and laparoscopic umbilical hernia repair, finding that laparoscopic repair is associated with lower rates of readmission and reoperation due to surgical site infection, but higher rates of reoperation due to severe complications.

Key Findings

Some key findings related to umbilical hernias include:

• Umbilical hernias can be symptomatic and require surgery 4.
• Mesh reinforcement is recommended for umbilical hernia repair to decrease recurrence rates 4, 5.
• Open and laparoscopic approaches have different advantages and disadvantages, and the choice of approach depends on the clinical situation 4, 6.