Umbilical Hernia Infants and Children: Reports7,8

immune to having a heart attack.
Two facts and may be dangerously mislead- Literature Cited

recent reports7,8 add further support ing. There are undoubtedly many peo- 1. Friedman M, Roseman RH: Type A
Behavior and Your Heart. New York,
to this statement. Each describes an ple doing distance running, both com- Knopf, 1974
acute fatal myocardial infarct occur- petitively and for recreation, who have 2. Bassler TJ: Marathon running and
immunity to heart disease. The Physician
ring in a 40-year-old man who had had serious heart disease and do not know and Sportsmedicine, April 1975
3. Morehouse LE, Gross L: Total Fit-
many years of experience as a com- it. Such a disease in the stage before ness in Thirty Minutes. New York, Simon
petition distance runner and was per- symptoms appear can only be detected and Schuster, 1975
4. Stamler J: Lectures on Preventive
forming at his best level at the time of by special testing (stress EKG and Cardiology. New York, Grune & Stratton,
his sudden unexpected death. Both apex EKG) which is not done in the 1967
5. Fletcher GF, Cantwell JD: Exercise
reports are documented by autopsy routine medical checkup. For this rea- and Coronary Heart Disease. Springfield, 1ll,
findings. son, all individuals (especially those CC Thomas, 1974
6. San Diego Track Club News Letter.
The oft repeated statement that the over 30) who compete or engage in a 15(12), December 1975
7. Henderson J: Running commentary.
ability to complete a marathon confers sport or activity requiring vigorous Runner's World Magazine 11:14-16, 1976
immunity to heart attacks for a certain physical exertion should have a maxi- 8. Green LH, Cohen SI, Kurland G:
Fatal myocardial infarction in marathon
number of years is not supported by mal stress EKG test. racing. Ann Intern Med 84:704-706, 1976
Umbilical Hernia in Infants and Children

James F. Densler, MD
Atlanta, Georgia
An umbilical hernia results from will be continued confusion as to the in adulthood. Prompt operative cor-
incomplete closure of the fascia of the proper time for operative intervention. rection of supraumbilical hernias is
umbilical ring through which intra- Much has been written about strap- also advised.
abdomninal organs can protrude. It is ping the umbilical hernia in infants. The operation for umbilical hernia
seen so often by pediatricians and Strapping the umbilicus relieves some is a simple one. Under general anes-
surgeons that it is considered an inci- of the anxiety of the parents but it is thesia a small curved incision is made
dental finding, however, this hernia is doubtful if it benefits the infant in in the loose skin of the umbilicus. The
a problem of deep concern to the hastening closure of the ring. The rate peritoneal sac is dissected from the
parents. of centripetal contraction of the um- fascia and closed by a pursestring or
The incidence of umbilical hernia is bilical ring is approximately 18 per- running suture of surgical gut. The
very high in premature infants. Evans1 cent of the area of the defect per edge of the rectus sheaths are approxi-
states that the incidence varies from month. It appears that after the infant mated in the midline with silk sutures.
84 percent in newborns weighing is fully ambulatory there is an increase To form a normal-appearing inverted
1,000 to 1,500 gm to 20.5 percent in in the rate of closure. The prognosis umbilicus, a silk suture is placed in the
those weighing 2,000 to 2,500 gm. For for spontaneous cure of supraumbilical undersurface of the most protuberant
some unknown reason umbilical hernia hernia is generally considered poor. In skin of the umbilicus and is brought
is more common in black than white some studies, however, healing of down and sutured to the anterior
children. Crump2 reported a 41.6 per- supraumbilical hernias has been noted surface of the fascia. The skin is closed
cent incidence in black infants under to occur comparably well, as in true with a few fine subcuticular sutures. A
one year of age. This incidence de- umbilical hernias.3 small piece of gauze is wadded up,
creased steadily to 15.9 percent at the The indications for surgical repair placed over the umbilicus, and fixed
age of four years and was essentially of an umbilical hernia must be eval- with adhesive tape. The child leaves
zero after eight years of age. Other uated on an individual basis.4-6 Specif- the hospital the morning following
studies show that fibrous proliferation ic symptoms which demand surgical surgery and returns for follow-up in
with complete obliteration of the um- treatment, regardless of age, are rare one week. The complication and re-
bilical ring occasionally is delayed as and operation in this group of children currence rates are nil.
much as two or three years but that is usually limited to complications of Literature Cited
after this age, the rate of spontaneous the hernia, namely, incarceration, 1. Evans AG: The comparative incidence
cure markedly decreases. Until addi- strangulation, or rupture. At the pres- of umbilical hernia in colored and white
infants. J Natl Med Assoc 33:158-160, 1941
tional studies are done on the natural ent time there is no unanimity of 2. Crump EP: Umbilical hernia occur-
history of the umbilical hernia, there rence of infantile type in Negro infants and
opinion as to the ideal time for elec- children. J Pediatr 40:214-223, 1952
tive repair. If there is protrusion and 3. Hutchin P: Somatic anomalies of the
umbilicus and anterior abdominal wall. Surg
the fascial defect measures 1/2 cm or Gynecol Obstet 120:1075-1091, 1965
larger, at 36-48 months, we believe 4. Gross RE: The Surgery of Infancy
and Childhood. Philadelphia: WB Saunders,
Presented at the "Clinical Quickies" pro- surgical repair is warranted. If an 1953, pp 227-235
gram at the 84th Annual Convention of the umbilical hernia exists in a female 5. Potts WJ: The Surgeon and The Child.
Georgia State Medical Association, June Philadelphia: WB Saunders, 1959, pp
15-17, 1977, Hilton Head Island, South infant at three years, surgical repair 122-129
Carolina. Requests for reprints should be seems indicated because of a possi- 6. Benson CD, Mustard WT: Pediatric
addressed to Dr. James F. Densler, 319 West Surgery. Chicago, Year Book Medical, 1969,
Lake Avenue NW, Atlanta, GA 30318. bility of a recurrence during pregnancy pp 317-328
JOURNAL OF TH E NATIONAL MEDICAL ASSOCIATION, VOL. 69, NO. 12, 1977 897

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immune to having a heart attack.

Two facts and may be dangerously mislead- Literature Cited

Umbilical Hernia in Infants and Children

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