Incarcerated umbilical cord hernia: a case report

Introduction

Congenital hernia of the umbilical cord (CHUC) is a rare developmental anomaly that results from the incomplete return of the midgut into the abdominal cavity during fetal development. It is often misdiagnosed as a small omphalocele and may be associated with serious gastrointestinal complications, although such occurrences are infrequently reported in the literature.

Case presentation

A 4-day-old male neonate was brought due to bilious emesis, abdominal distension, and failure to pass meconium since birth. The perinatal history was unremarkable, but detailed ultrasonography had not been performed. Postnatally, the patient had poor sucking and intolerance to breastfeeding. Initial examination revealed an incarcerated umbilical cord hernia. The abdomen was markedly distended with full flanks, shiny erythematous skin, and tenderness with guarding, raising suspicion for a bowel perforation and peritonitis. Reduction of the hernia was not attempted. Radiographic imaging revealed pneumoperitoneum. The patient was taken for an emergency exploratory laparotomy, which was done through a transverse supraumbilical (infraumbilical, please see the figure) incision. We found a congenital hernia of the umbilical cord (CHUC), a segment of ileum incarcerated in the CHUC that had a Meckel's diverticulum, was necrotic and had two sites of perforation. We resected the necrotic segment which was 24 cm long, and did a primary end-to-end anastomosis. Enteral feedings with formula were initiated on postoperative day 5 and fully tolerated by the postoperative day 10. The patient was discharged in stable condition on the 16th day of life.

Conclusion

Umbilical cord hernias are generally benign malformations but can occasionally become incarcerated, causing intestinal obstruction and even intestinal necrosis.