UMBILICAL CORD HERNIA

This is a ventral wall defect in which the bowel usually herniates into the base of a normally inserted umbilical cord through a patent umbilical ring.

• Umbilical cord hernia has similar morphological features to omphalocele and both terms have been used interchangeable in perinatal literature.
• Some authors have described it as a small omphalocele (1) while other workers (2) have used the term "transient omphalocele" to describe a sliding umbilical cord hernia.
• The umbilical cord hernia is thought to result later in embryogenesis, after completion of the normal formation of the primitive umbilical ring by the four body folds at 3 weeks, and normal elongation of the intestine into the umbilical celom at about 5 weeks. During weeks 10-12 when the intestine normally returns to the peritoneal cavity, this process is interrupted, leaving the intestines in the umbilical cord celom, covered by amnion and chorion (3).
• Differentiation of umbilical hernia from omphalocele.
• Morphology of the umbilical ring.
• normal insertion of the cord into the umbilical ring with intact skin covering the ring in umbilical hernia. Rectus muscles have a normal midline insertion close to the xiphoid.
• large defect in the umbilical ring involving the adjacent muscles and skin in omphalocele.
• Contents within the defect.
• intestines that protrude into the base of the ring in umbilical hernia.
• intestines, liver and other abdominal viscera may be contained in the omphalocele.
• Associated Anomalies.
• Rare, except for malrotation and volvulus (1).
• Table comparing omphalocele, gastroschisis and physiological hernia.

REFERENCES

1. Knochel JQ, Lee TG, Melemdez MG, Henderson SH. Fetal anomalies involving the thorax and abdomen. Radiol Clin North Am 1982;20:297-310.
2. Bromley B, Benacerraf BR. Transient omphalocele. J Ultrasound Med 1992;12:688-689.
3. Achiron R, Soriano D, Lipitz S et.al. Fetal midgut herniation into the umbilical cord: improved definition of ventral abdominal anomaly with the use of transvaginal ultrasound. Ultrasound Obstet Gynecol 1995;6:256-260.