Umbilical hernias are protrusions of abdominal organs through the abdominal wall near the umbilicus. They can be classified as reducible if the contents can be pushed back into the abdomen, or irreducible if they cannot. Diagnosis involves examination, palpation, and sometimes imaging. Small, reducible hernias may resolve on their own, while larger or irreducible hernias may require surgical repair by dissecting out the sac, ligating the neck, and closing the defect with or without mesh if there is significant tissue loss. Postoperative complications can include infection, adhesions, or dehiscence.

2. UMBILICAL HERNIA

3. Definition
• It is the protrusion of an organ or part of an organ
through the wall of the cavity normally containing
it.

4. 1. RING
2. SWELLING

5. Classification of hernia
DIRECT INDIRECT

6. LOCATION:
• 1- External hernias: it occurs through the
body wall producing a visible and palpable
swelling covered by skin as umbilical H.
and Ventral H
• 2- Internal hernias: it occur within the
abdominal cavity. As diaphragmatic H.

7. 3-Incisional or postoperative
hernias:
• encountered relatively frequently following
abdominal surgery. Improper closure of the
incision, suture breaking or tearing through
tissues, postoperative wound infection, are
contributory factors. The weakened
abdominal wall undergoes loss of continuity
and a hernia develops often a delay of
several weeks or months

8. • 1. According to their situation: e.g.
umbilical H. (omphalocele or exomphalos),
inguinal H. (bubonocele), scrotal H.
(oscheocele), or ventral H., femoral H. and
perineal hernia.

9. • 2. According to the nature of the hernial
contents: e.g. that containing the bowel
with the mesentry (enterocele), omentum
(epiplocele) and bladder (vesicocele).

10. • 3. According to the condition of the
hernial contents:
• This may be: 1. Reducible or mobile hernia
(more common)
• In which the hernial contents can be
returned to the abdominal cavity through
the hernial ring.

11. • 2. Irreducible hernia: in which the
contents can not be returned to their normal
location. It comprises three types:-
• A- Incarcerated hernia: is one in which
the passage of the ingesta through the
protruding loop of intestine is arrested. The
blood flow in its wall, however is
maintained

12. • B- Strangulated hernia: is one in which both
irreducible and incarcerated and in which the
blood circulation is also arrested and the lumen of
the bowel is obstructed resulting in gangrene
within 24 hours unless speedy relief is afforded..
• C- Hernia with adhesion: inflammatory
adhesions may have united the contents to the
lining of the sac. They prevent the complete
reduction of the hernia and may cause
strangulation by constricting the bowel.

13. • Aetiology: I- Predisposing causes:
• 1- Congenital or herditary as umbilical and
inguinal hernias .
• 2- Weak abdominal wall e.g. imperfect occlusion
of the umbilicus.
• 3- Deep wounds, contusions and abscesses.
• 4- Increased intra-abdominal pressure e.g.
straining from constipation or diarrhoea or
parturition, fits of coughing or intestinal tympany.

14. II. Exciting causes:
• 1- Mainly increased intra-abdominal
pressure with rupture of the rigid muscles
tends to force the viscera via weak points in
the abdminal wall.
• 2- Violent impact against a blunt object
with rupture of the muscle while the skin is
intact.

15. • Symptoms Physical symptoms
• 1- It is due to the presence of hernial swelling
which varies in shape and size.
• 2- In enterocele, it is elastic and in epiplocele it is
doughy to feel; manipulation of the former may
produce a gurgling sound.
• 3- If the herniated portion of the intestine is
distended with gses, it will be tympanic on
percussion and if it is containing a quantity of
fluid it will fluctuate on palpation.

16. • 4- In entero-epiplocele there is a combination of
the foregoing characters.
• 5- In the vast majority of cases, gentle pressure on
the protruding swelling will reduce the hernia,
allowing identification of the hernial ring, which
should be assessed for size, shape and rigidity.
Reduction of the bowel is more easily and sudden
than the reduction of other organs.

17. • In both small and large animals operative
interference is contra-indicated between the
first to the tenth day of development of the
hernia when the hernia is not accompanied by
signs of intestinal obstruction, it is advisable to
delay surgery for 3-6 weeks until some swelling
has subsided and deposition of collagen has
increased the tensile strength of the damaged
tissues as one cannot expect sutures to hold in
the infiltrated tissues surrounding it

18. Hernioplasty
(Hernial Prosthesis)
•
•
•
Large h. ring
Weak spot(scar) present
Large loss of tissue on edges
•
•
•
Allow approximation
without tension
Bridge the gap
Avoid reccurrence of hernia

19. Diagnosis
• Symptoms:
• 1. Physical :
• Swelling – variable in
size
• (abscess, hematoma ,
cyst, neoplasm )- aseptic
exploration

20. • Palpation of ring
• Consistency of sac: enterocele(elastic), epiplocele
(doughy)

21. Diagnosis
• Functional symptom
• Absent in reducible and
non- complicated hernia
• Colic in incarcerated
hernia
• Severe pain, temp.etc

22. Radiography

24. Complications of hernia
• Adhesions
• Hydrocele of sac
• Incarceration-absorption of water in enterocele-
making reduction difficult
• Torsion
• Strangulation-called as acute hernia

25. Umbilical hernia 'omphalocele

26. Umbilical Hernias:
• Umbilical hernias vary in size and may
contain only fat or omentum, or in more
severe cases, intestinal loops.
• Many male dogs with umbilical
hernias are cryptorchid.
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27. Types;
• Reducible: can be reduced into the
abdominal cavity
• Irreducible: contents are irreducible due to
Intestinal strangulation or obstruction &
require emergency surgical correction
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28. Diagnosis
• observation of the hernia sac, palpation
• Examination in dorsal recumbency
facilitates reduction of the contents of the
hernia and hernia ring palpation
• Fine needle aspiration in asceptic
condition.
• ultrasonography, and possibly
radiographs.
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29. • Differential diagnoses: abdominal
swellings with abscess,cellulitis,
hematoma or seroma, and neoplasia.
Treatment
Most small, reducible umbilical
hernias in dogs and cats contain only
falciform fat and are of little clinical
significance
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30.  Many umbilical hernias resolve
spontaneously in young animals or are
small and are not corrected until the animal
is neutered. Spontaneous closure may
occur as late as 6 months of age.
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31. The hernial ring is not palpable in some
animals because the ring closes
subsequent to herniation of
falciform fat or omentum.
Occasionally, intestine or other abdominal
structures can be palpated; they generally
can be reduced into the abdominal cavity.
If the umbilical sac is warm or painful
and the contents are irreducible,
Intestinal strangulation or
obstruction should be suspected.
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32. SURGICAL TREATMENT
• Ventral midline approach
• When umbilical hernias are corrected at
ovariohysterectomy, the hernia repair is
completed during routine abdominal
wall closure. The initial skin incision is
extended cranially over the hernia sac.
• Alternatively, an elliptical incision is
made around the base of a large sac to
remove redundant tissue.
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33. • Skin margins are retracted, and the sac is
dissected free.If fat alone is present in the
sac, the neck of the hernia is ligated and
the sac and remaining contents are
excised.
• Small sacs with no internal adhesions can
be inverted into the abdomen.
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34. • Umbilical hernias containing abdominal
organs may require more extensive
surgery. The skin incision is made around
the base of the hernia, leaving enough skin
to close the defect without tension.
• In incarcerated hernias without
strangulation, the hernia sac is dissected
free without damaging the contents.The
hernia ring is enlarged along the linea alba
to release the contents into the
abdomen.Release contents are inspected
for viability.
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35. • Releasing incisions can be made to
reduce tension on the primary suture line,
provided that the rectus muscles and
underlying fascia have adequate strength.
• Incision are made 2 cm away from the
defect through the external rectus
fascia only.
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36. • The fascia is elevated or dissected off the
rectus abdominis muscle and shifted
towards midline, thereby reducing tension
on the primary repair.
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37. • Synthetic mesh(Hernioplasty) must be
used to repair the defect when some
muscle part is lost due to trauma, bite or
due to dehiscence
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38. • Abdominal hernias secondary to bite
wounds usually are contaminated; wound
infection and dehiscence of the skin or
hernial repair (or both) are common.
• No absorbable mesh should not be
placed in these hernias i.e Hernioplasty
, and the wounds should be drained .
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