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Case Reports
. 2023 Jun:107:108352.
doi: 10.1016/j.ijscr.2023.108352. Epub 2023 May 24.

Spontaneous evisceration of infantile umbilical hernia

Ahmed Kamel Ali  1 , Moataz Elagan  2 , Fatma A Monib  2 , Tarek Abdelazeem Sabra  3
Affiliations
Case Reports

Spontaneous evisceration of infantile umbilical hernia

Ahmed Kamel Ali et al. Int J Surg Case Rep. 2023 Jun.

Abstract

Introduction and importance: Infantile umbilical hernia is common in children. It has a regressive course in most cases. Conservative management is the standard in most cases before the age of 3 years unless there are complications such as incarceration, rupture with evisceration which are extremely rare and warrants emergency surgery.

Case presentation: Our case was a full term 6-month-old male of normal birth weight with history of umbilical hernia but with no obvious risk factors to develop complications. The loops evisceration was spontaneous with a small umbilical skin damage. The poor parental consultation on early surgical management and delayed presentation of the infant after evisceration could be the possible risks for ischemic changes and shock state at the time of presentation, however, prompt medical resuscitation and surgical management relatively improved postoperative outcomes.

Clinical discussion: Infantile umbilical hernia is considered one of the most encountered abnormalities of infancy. Most umbilical hernias are asymptomatic and discovered after birth. Complications of infantile umbilical hernia as incarceration or spontaneous evisceration are very rare but fatal. Certain factors increase the risk for developing spontaneous rupture of infantile umbilical hernia including the age of the infant or child, the defect size, umbilical sepsis or ulceration and any condition which raises intra-abdominal pressure, i.e., crying, coughing or positive ventilation.

Conclusion: Although infantile umbilical hernia is clinically benign condition with a regressive course in majority of cases, the risk of rupture of an umbilical hernia is exceedingly rare in pediatric population; physicians should be warranted with the possible risk factors for spontaneous rupture and in these patients expedite surgical repair.

Keywords: Bowel evisceration with gangrene; Complicated paediatric umbilical hernia; Herniorrhaphy; Pediatric patients; Spontaneous rupture; Umbilical hernia.

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Conflict of interest statement

Declaration of competing interest The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Figures

Fig. 1
Fig. 1
a: Eviscerated bowel loops with elastic sheet. b: The elastic coverage used to cover the eviscerated bowel loops.
Fig. 2
Fig. 2
Clinically ischemic eviscerated bowel loops through small umbilical defect.
Fig. 3
Fig. 3
a: Eviscerated bowel loops with the tool in the skin defect at the summit of umbilicus. b: The discrepancy in color between viable and non-viable small intestine.
Fig. 4
Fig. 4
two layered jejunoileal anastomosis 5 cm far from ileocecal junction.
Fig. 5
Fig. 5
a: Facial defect after reduction of bowel loops. b: Skin closure with umbilicoplasty.
See this image and copyright information in PMC

References

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