Umbilical hernia occurs as a result of imperfect closure or inherent weakness of the umbilical ring. It is 6 to 10 times more common in low birthweight female and black infants and 60-80% of premature infants present with it(1). Umbilical hernias are usually free from com-plications, the commonest being incarceration, followed by strangulation, only a small percentage (5%) of which become gangrenous including perforation of the content, pain and rupture following trauma(2). Spontaneous rupture of infantile umbilical hernia is extremely rare and we report such an occurrence.

The 4.7 kg 8-month-old female infant presented with evisceration of bowel following spontaneous rupture of umbilicus one day back. The infant had an umbilical hernia since birth and was suffering from recurrent umbilical sepsis since the age of 1 month. There was no history of trauma or topical application of unprescribed herbal medicine. The infant was stabilized by giving intravenous dextrose saline and antibiotics. Then abdomen was opened under general anesthesia by transverse incision and peritoneal lavage was done. The prolapsed bowel was reduced and double breasting of umbilical defect was done with vicryl 20, Pre rupture size of umbilical hernia was 4.5 cm and hernia defect size was 2 cm in diameter. The patient was discharged after 3 days and was asked to come twice at monthly intervals. There have been no complaints since then.

Most umbilical hernias that appear before 6 months of age disappear spontaneously by 1 year. Complications are seen more often in malnourished children of low socioeconomic strata, being brought up in unhygienic surroudings(3). In this case, there was no history of factors such as coughing or prolonged crying which could have precipitated the rupture. Also as already mentioned, there was no history of trauma or topical medication which often cause inflammation and necrosis of overlying skin(4) and increase chances of spontaneous rupture. Recurrent umbilical sepsis since the age of 1 month was probably perpetuated by sweat, warmth and friction. This was likely as the tear was located on inferior surface of the hernial sac, which being the most dependent part was attached to the overlying inflammed and necrosed skin(5).

Utpal Kant Singh,
Shivani Singh,
Purnendu Ojha,
Ranjeet Kumar,
Upgraded Department of Pediatrics,
Patna Medical College, 
Patna 800 016, India.

References

1. Nmadu PT. Pediatric external abdominal hernias in Zaria, Nigeria. Ann Trop Paediatr 1995; 15: 85-88.

2. James PM. The problems of hernia in infants and adolescents. Surg Clin North Am 1971; 51: 1360-1.

3. Obianyo NE. Umbilicoplasty after herniorrhaphy for giant umbilical hernia in children. Nig J Surg 1994; 1: 18-21.

4. Strange SL. Spontaneous rupture of an umbilical hernia in an infant. Postgrad Med J 1956: 32: 39.

5. Ahmed A, Ahmed M, Nmadu PT. Sponta- neous rupture of infantile umbilical hernia: Report of three cases. Ann Trop Pediatr 1998; 18: 239-241.