Umbilical hernia differential diagnosis

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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]

Overview

Umbilical hernia must be differentiated from epigastric hernia, Spigelian hernia, and incisional hernia.

Differentiating umbilical hernia from other Diseases

• Umbilical hernia must be differentiated from epigastric hernia, Spigelian hernia, and incisional hernia.

Abdominal hernias differential table

Differential Diagnosis	Similar Features	Differentiating Features
Umbilical Hernia	On physical exam; reducible, visible with valsalva and disappears with laying flat, non- tender.	Location: Linea alba through weakened umbilical ring. Paraumbilical hernias through linea alba in the region of the umbilicus.
Epigastric hernia	On physical exam; reducible, visible with valsalva and disappears with laying flat, non- tender.	Location: Linea alba between umbilicus and xiphoid process.
Spigelian hernia	On physical exam; reducible, visible with valsalva and disappears with laying flat, non- tender.	Location: Semilunar line: along the lateral borders of rectus abdominus. Herniation typically occurs caudally (below arcuate line) due to absence of posterior rectus sheath.
Incisional hernia	On physical exam; reducible, visible with valsalva and disappears with laying flat, non- tender.	Location: Site of prior incision.

Abdominal Hernias

Abdominal wall

Groin

Umbilical

Epigastric

Spigelian

Incisional

Abdominal hernia differential [Source:Sketch courtesy of Dr. Hamid Qazi]