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 then 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, usually within the proximal portion of the umbilical cord.
• 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.