Infants and young children have a lump in the umbilicus

Introduction Infant umbilical hernia is a congenital developmental deficient disease that gradually decreases with age. Most can heal themselves within 2 years of age. The surface of the sputum has skin covering mainly in the umbilicus with a prominent mass, the mass is enlarged when crying, the skin tension is very thin, the micro-cyan is quiet, lying down or the tumor shrinks away during sleep, and the umbilicus has loose wrinkles. The umbilical scar is a congenital weakness after the baby's umbilical cord is detached, and the anterior and posterior sheath of the rectus abdominis in the infant is not closed in the umbilicus, leaving a defect, and the conditions for the formation of umbilical hernia are various causes of increased intra-abdominal pressure. Such as cough, diarrhea, excessive crying, etc., can promote the occurrence of umbilical hernia.

Cause

The cause of swelling in the umbilicus of infants and young children:

The umbilical scar is a congenital weakness after the baby's umbilical cord is detached, and the anterior and posterior sheath of the rectus abdominis in the infant is not closed in the umbilicus, leaving a defect, and the conditions for the formation of umbilical hernia are various causes of increased intra-abdominal pressure. Such as cough, diarrhea, excessive crying, etc., can promote the occurrence of umbilical hernia.

The umbilicus is the last part of the abdominal cavity that is closed to the umbilical cord of the fetus. The umbilical vein is in the uppermost part of the umbilicus, passes through the abdominal wall, and moves inward to the umbilical vein near the umbilicus at the lower edge of the sacral ligament to become the hepatic round ligament. The two umbilical arteries at the time of the fetus are located between the transverse fascia and the peritoneum and enter the umbilical cord on the lower side of the umbilicus. The fibrotic cord is degenerated into a umbilical ligament after birth. The urinary tract of the fetus is located between the midline of the lower abdomen, the abdominal wall and the peritoneum, and is degenerated into a umbilical ligament after birth. At the time of birth, the umbilical cord is ligated and cut, and the scar is formed. The upper ligaments are filled with loose connective tissue and become the weakest part of the abdominal wall. The umbilical ring surrounds the umbilical cord and is tough. It is composed of the anterior and posterior fascia of the rectus abdominis and the transverse fascia of the abdominis. The umbilical ring is larger at birth, gradually shrinks during the growth process, and eventually disappears. When the umbilical ring is larger, the gap between the ligaments increases, and the abdominal viscera carries the peritoneum through the space between the ligaments and protrudes outside the umbilical ring to form the umbilical hernia. Infants, especially premature infants, low birth weight infants, malnourished children and children with cerebral dementia, have poor tissue development around the umbilicus or have a slower contraction and closure of the larger umbilical ring of the umbilical ring. Anatomical factors of umbilical hernia.

Another person did histological studies. During the fetal period, the elastic fibers in the umbilical artery wall continued to extend around, reinforcing the lower part of the umbilicus around the umbilical artery and umbilical urethra, just like the sphincter. After the umbilical cord is detached, the umbilical ring is locked, and the sphincter structure is not tightly surrounding the umbilical vein in the lower part of the umbilical ring, so that the upper part of the umbilicus is weaker than the lower part, so umbilical hernia is easy to occur in the upper part.

an examination

Related inspection

Infant health check umbilical examination

Examination and diagnosis of swelling of the umbilical part of infants and young children:

Umbilical hernia is the most common form of umbilical disease. The incidence of infants is higher, especially in premature infants with low birth weight. As the age increases, the incidence gradually decreases. It has also been reported that the incidence of black races is higher than that of Caucasians. Blumberg (1980) observed 1865 children in South Africa. The incidence of black and white people was found to be significantly different, mainly in infants under 1 year old. After 1 year of age, the difference between the two types of people gradually narrowed, and the incidence rate after 3 years old was similar.

The incidence rate is 5% to 10% in newborns, mostly in premature infants. It has been investigated that the incidence of neonatal umbilical hernia with a body weight of 1000-1500 g is 84%, and between 2000 and 2500 g is 20.5%. Girls are 2 to 3 times more likely than boys.

It occurs in the babies several days and weeks after the umbilical cord falls off. At this time, the umbilical cord has an epithelium formed at the cut site. Therefore, the surface of the sputum has skin coverage mainly in the umbilicus, and the mass is enlarged when crying. The skin is very thin, slightly cyan, quiet, lying down or sleeping, the tumor shrinks and disappears, and there are loose wrinkles in the umbilicus. After the content of the sputum is returned by fingers, the sound of water can be heard and the tissue can be touched hard. The umbilical ring, with the fingers deep into the umbilicus, can be estimated to the diameter of the umbilical ring when the child coughs, crying, and the fingers can have a sense of impact.

complication:

1. Adhesive adhesion: When it is stuck, it can cause umbilical pain, especially when the omentum sticks in the hernia sac. The pain is more obvious, and sometimes it can cause abdominal distension and vomiting.

2. Umbilical hernia incarceration: The contents of umbilical hernia are mostly incarcerated in the small intestine and omentum. Once the umbilical hernia is incarcerated, various symptoms are exacerbated.

3. The umbilical hernia is worn out: the umbilical hernia sac and the cover are thin, and it is easy to break through when there is external force.

Differential diagnosis

Differential diagnosis of swelling of the umbilicus in infants and young children:

1, umbilical swelling: umbilical fossa moist, swelling, exudation of odor, may be purulent or mixed with blood is a clinical diagnosis of umbilical inflammation. Omphalitis is a bacterial infection of the umbilical stump. According to the age of onset, there may be adult ointment and neonatal umbilical inflammation. According to the pathological process, there are two kinds of acute omphalitis and chronic omphalitis. Acute umbilical inflammation is an acute cellulitis of the umbilical cord tissue. If the infection progresses, it may be complicated by abdominal cellulitis, or it may develop into a peri-umbilical abscess, and there is a risk of complicated peritonitis and sepsis. The pathogen is Staphylococcus aureus and the like. Chronic umbilical inflammation is a kind of chronic inflammatory manifestation of umbilical cord caused by irregular treatment, long-term unhealed or unhealed wounds and local foreign body stimuli after umbilical cord detachment.

2. There is granulation tissue hyperplasia in the umbilical fossa: there is granulation tissue proliferation in the umbilical fossa. The wound that has not healed after the umbilicus is stimulated by foreign body or often rubbed to form a polypoid, cherry red granuloma, which is the size of rice to soybean. There is a pus and bloody secretion, it is not easy to heal. Excessive granulation tissue can be removed with 10% silver nitrate or with sterile scissors to keep it clean and quickly heal. The granulation tissue proliferation in the umbilical fossa is a kind of tissue hyperplasia that occurs after the umbilical cord falls off. It may also be caused by the intestinal tube connecting with the navel and the mucous membrane bulging. Umbilical granuloma is very likely to cause infection and cause inflammation. It is an umbilical disease that requires immediate medical attention.

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