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Pediatric Surgery Management and Referral Guidelines

Pediatric Surgery Management and Referral Guidelines

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Pediatric Surgery Management and Referral Guidelines

Umbilical Hernia (K42.9)

Diagnosis: ICD-10

Umbilical hernia: K42.9

Target Population • Infants • Children • Young adults

Clinical Findings

• An umbilical hernia is a muscular defect in the abdominal wall that occurs directly under the belly button.

• They are characterized by umbilical protrusion during straining or valsalva maneuver.

• With a calm child, they are usually easily reducible and are often present since birth. Most umbilical hernias will resolve spontaneously by 5 years of age.

• Umbilical hernias are treated differently than other abdominal wall hernias.

Evaluation Recommendations

1. Asymptomatic children: In patients with an umbilical hernia that is easily reducible, observation is recommended until patients are 5 years of age. If the hernia is still present after 5 years of age, repair is generally indicated because of the lifelong risk of an incarceration event. Patients do not need to be seen till they are 5 years old by the surgical service if they remain asymptomatic.

2. Symptomatic children: In children of any age, if the hernia

will not reduce or is difficult to reduce, then surgical repair is indicated and these patients should be seen right away.

No imaging or lab work is necessary for the work up of children with an umbilical hernia.

Red Flags

• Signs of an incarcerated umbilical hernia include a hard umbilical mass that won’t reduce and may be associated with pain and redness at the site, abdominal distension, and emesis (sometimes bilious). This is an emergency that should be sent immediately for surgical consultation either in the office or Emergency Department.

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Pediatric Surgery Management and Referral Guidelines

These recommendations are designed to be used by primary care physicians wishing to refer their patients with an umbilical hernia to surgery. They are based on best evidence and expert consensus opinion.

Treatment Recommendations

• Asymptomatic infants and children less than 5 years old should be observed and referred for elective surgical evaluation after they are 5 years old if the hernia is still present. Surgical referral before this time is unnecessary.

• Patients of any age with a hernia that is difficult to reduce in a calm child, should be sent for surgical evaluation. (See Red Flags above)

Ancillary Documentation

Needed

• Referral request

Additional Information

1. Zendejas B, et al. Fifty-three-year experience with pediatric umbilical hernia repairs. J Pediatr Surg. 2011 Nov;46(11):2151-6.

If at any time patient develops signs/symptoms that make more urgent evaluation important, please alert Pediatric Surgery (512-708-1234) to this change in status or go to the Emergency Room.