Dr. RAJENDRAN’S INSTITUTE OF MEDICAL EDUCATION • Innovat
Dr. Rajendran Rajendran
Dr. RAJENDRAN’S INSTITUTE OF MEDICAL EDUCATION
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Hernia common in children-

a. Umbilical

b. Bochdalek

c. Morgagni

d. Inguinal



Ans: (a)

Umbilical hernia

Failure of the umbilical ring to close results in a central defect in the linea alba. A fascial defect at the umbilicus is frequently present in the newborn, particularly in premature infants. The resulting umbilical hernia is covered by normal umbilical skin and subcutaneous tissue, but the fascial defect allows protrusion of abdominal contents.

Umbilical hernias are generally asymptomatic protrusions of the abdominal wall. In most children, the umbilical ring progressively diminishes in size and eventually closes. Fascial defects less than 1 cm in diameter close spontaneously by 5 years of age in 95% of cases and, in most cases, should not undergo early repair. When the fascial defect is greater than 1.5 cm in diameter, it seldom closes spontaneously.

Unlike inguinal hernias, protrusion of bowel through the umbilical defect rarely results in incarceration in childhood. Surgical repair is indicated if the intestine becomes incarcerated, when the fascial defect is greater than 1.5 cm and in all children over 4 years of age.

Incarceration presents with abdominal pain, bilious emesis, and a tender, hard mass protruding from the umbilicus. This constellation of symptoms mandates immediate exploration and repair of the hernia to avoid strangulation.

Inguinal hernia

Inguinal hernia is a common condition in infancy and childhood. Unlike hernias in adulthood, these nearly always result from a patent processus vaginalis (indirect hernia) and not from a weakness in the floor of the inguinal canal (direct hernia). The processus vaginalis follows the descent of the testis into the inguinal canal. Failure of obliteration of the processus may lead to a variety of anomalies, including hernia, communicating hydrocele, non-communicating hydrocele, hydrocele of the spermatic cord, and hydrocele of the tunica vaginalis.

The processus vaginalis remains patent in over 80% of newborn infants. With increasing age, the incidence of patent processus vaginalis diminishes. At 2 years, 40%-50% are open, and in adults 25% are persistently patent. Actual herniation of bowel into a widely patent processus vaginalis develops in 1% - 4% of children; 25% occur within the first year of life.

• Pediatric Surgery > INGUINAL HERNIA & HYDROCELE
o CURRENT Diagnosis & Treatment: Surgery, 14e, Chapter 43

Dr. RAJENDRAN’S INSTITUTE OF MEDICAL EDUCATION
• Innovative new way of learning medicine anytime anywhere
• New MCQs not yet asked but likely to be asked in coming PG medical entrance exams
• Difficult topics made easy
• Thoroughly referenced all correct answers

To receive MCQs like these to your mobile, send WhatsApp message ‘mcq’ to + 91 93888 52220.

RIME TEAM
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