Incarcerated Umbilical Hernia: Definition and Management
An incarcerated umbilical hernia requires immediate surgical intervention when signs of strangulation, intestinal obstruction, or perforation are present, as delayed treatment beyond 24 hours significantly increases mortality. 1, 2
What is an Incarcerated Umbilical Hernia?
An incarcerated umbilical hernia occurs when hernia contents (such as omentum or bowel) become trapped and irreducible due to:
- A narrow opening in the abdominal wall
- Adhesions between the hernia contents and the hernia sac 1
This condition can progress to more serious complications:
- Intestinal obstruction - blockage of normal bowel function
- Strangulation - compromised blood supply to the hernia contents, which can lead to tissue necrosis
- Perforation - rupture of the bowel wall due to tissue death 1
Urgent vs. Emergency Management
Immediate Surgical Intervention Required When:
- Signs of strangulation are present
- Intestinal obstruction has developed
- Perforation has occurred
- Patient shows hemodynamic instability
- Signs of peritonitis are present 1, 2
Timing Considerations:
- Mortality significantly increases when treatment is delayed beyond 24 hours in complicated cases 2
- For pregnant women with incarcerated umbilical hernias, emergency repair is indicated 2
Diagnostic Approach
Color Doppler ultrasonography is valuable for:
- Assessing blood flow in the incarcerated bowel
- Ruling out necrosis (a contraindication for manual reduction)
- Guiding potential reduction attempts 3
Treatment Options
Manual Reduction:
- May be attempted in selected cases to avoid emergency surgery
- Should only be performed if strangulation is ruled out
- Ultrasonography can guide the procedure and identify obstacles to reduction
- Fluid in the hernia sac may need to be drained to facilitate reduction 3
Surgical Management:
- Open repair is recommended for patients with hemodynamic instability or suspected bowel compromise
- Laparoscopic approach may be considered for stable patients without signs of strangulation or peritonitis
- Mesh reinforcement is typically recommended for defects >3 cm that cannot be closed primarily 2
Special Considerations
Pediatric Patients:
- Incarceration of umbilical hernias in children is more common than generally believed
- Active observation is necessary to prevent morbidity from incarceration
- Hernias larger than 1.5 cm in diameter appear to have higher risk of incarceration 4
Pregnant Women:
- Pregnancy may cause herniation or make a preexisting hernia apparent due to increased intra-abdominal pressure
- Emergency repair is indicated if the hernia is incarcerated or strangulated
- For asymptomatic hernias, repair should be postponed until after childbirth 5
Potential Complications
Common complications of hernia repair include:
- Hematoma (1.6-1.86%)
- Seroma (0.4%)
- Wound infection (0.4-1.6%)
- Chronic pain 2
Key Takeaway
Incarcerated umbilical hernias represent a potentially serious condition requiring prompt evaluation. While not all cases need immediate surgery, the presence of strangulation, obstruction, or perforation constitutes a surgical emergency. Point-of-care ultrasonography is valuable for assessment and potential guided reduction in appropriate cases, but surgical intervention should not be delayed when indicated by clinical findings.