Umbilical hernia pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]

Pathophysiology

The pathophysiology of umbilical hernia is as follows:

• During fetal development, the abdominal wall is formed by four separate embryologic folds:
  • cephalic
  • caudal
  • right and left lateral
• Each fold is composed of somatic and splanchnic layers.
  • The folds develop towards the anterior center portion of the coelomic cavity (i.e., the hollow, fluid-filled cavity lined by an epithelium derived from mesoderm in humans) and ultimately join to form a large umbilical ring that surrounds the following structures:
    • The two umbilical arteries
    • The umbilical vein
    • The yolk sac (i.e., omphalomesenteric duct)
  • These structures are enclosed by the outer layer of amnion. The entire unit, itself, comprises the umbilical cord.

• During the time between fifth and tenth weeks of gestation, the intestinal tract undergoes rapid growth with protrusion of the abdominal content outside the abdominal cavity.
• This is followed by a gradual re-entry of the abdominal cavity and then the ultimate narrowing of the umbilical ring which completes the process of abdominal wall formation as fetal development concludes.
•  Weak fascia or failure to fully form the fascia may predispose the newborn to an umbilical hernia.