Hernia of the umbilical cord: a clinical spectrum
DOI:
https://doi.org/10.18203/2349-3291.ijcp20195741Keywords:
Associated anomalies, Cecum and appendix, Congenital hernia of umbilical cord, Ileal loops, Meckel’s diverticulum, OmphaloceleAbstract
Background: Hernia of the umbilical cord is a rare clinical entity which presents with hernia of the small bowel into the proximal part of the umbilical cord. This is sporadically associated with other congenital malformations. This is usually poorly identified and mistakenly termed as ‘omphalocele minor. Inadvertent clamping of the cord in these cases leads to iatrogenic bowel wall injury. The aim of this study is to present a spectrum of cases presenting with umbilical cord hernia in a tertiary care Govt medical college, along with demography, intra operative findings, associated malformations and postoperative outcome and 1 year follow up.
Methods: This is an ambispective study on neonates who attended the Outpatient Department (OPD) or Emergency department. The babies were evaluated by age, birth weight, gender, any gross clinical malformation. They were also evaluated intraoperatively for any associated anomalies. Post-surgery the babies were followed up until 2 years of age in pediatric surgery OPD of the same institute and outcome was recorded.
Results: Out of 90 babies, 88 babies (97.77%) had body weight more than 2.5 kg, and rest 2(2.22%) had bodyweight of 1.5kg and 1.8 kg. Regarding content of contents of umbilical cord hernia, out of 87 patients, 43 patients (49.42%) had ileal loop as, 32 patients (36.78%) had ileum with Meckel’s diverticulum, 6 patients (6.39%) had cecum with appendix.
Conclusions: Most of this study cases had ileal loops as content of the hernial sacs, and 36.78% cases had Meckel’s diverticulum associated, which is a remnant of Vitello intestinal duct. Prompt identification of the condition and early intervention and adequate post-natal care are affective to prevent long term morbidity.
References
Raju R, Satti M, Lee Q, Vettraino I. Congenital hernia of cord: an often-misdiagnosed entity. Case Reports. 2015:2015.
Mirza B, Ali W. Distinct presentations of hernia of umbilical cord. J Neonatal Surg. 2016;5(4).
Sadler TW, Langman J. Langman’s essential medical embryology. 12th ed. Philadelphia, PA: Lippincott Williams and Wilkins, 2010;195-212.
Predanic M, Perni SC, Chasen ST, Baergen RN, Chervenak FA. Assessment of umbilical cord coiling during the routine fetal sonographic anatomic survey in the second trimester. J Ultrasound Med. 2005;24(2):185-91.
Burns CW, Ogryzlo MA. Congenital hernia into the umbilical cord; two cases, one associated with persistent cloaca. Canad Med Associat J. 1938;39(5):438.
Pal K, Ashri H, Wabari AA. Congenital Hernia of the Cord. Indian J Pediatr. 2009;76 (3):319-21.
Philipp EE. Victor Bonney: The Gynaecological Surgeon of the Twentieth Century. JRSM. 2001 Jun; 94(6): 311-2.
Gupta R, Mathur P, Gupta PK. Congenital Hernia of the Umbilical Cord associated with type IIIa Ileal Atresia. J Neo Surg. 2016 Oct;5(4):64.
Pal K. Congenital hernia of the umbilical cord associated with extracelomic colonic atresia and perforation of gut in a newborn. African J Paediatr Surg. 2014;11(1):74.
Mirza B, Mirza A, Hashim I, Saleem M. Hernia of umbilical cord: report of three unusual cases. J Neo Surg. 2015;4(2).
Achiron R, Soriano D, Lipitz S, Mashiach S, Goldman B, Seidman DS. Fetal midgut herniation into the umbilical cord: improved definition of ventral abdominal anomaly with the use of transvaginal sonography. Ultrasound Obstetr Gynecol: Official J Intern Soc Ultrasound Obstetr Gynecol. 1995;6(4):256-60.
