Um nalvalopið hjá pinkubørnum: Hernia umbilicalis infantum

Abstract

Hans Debes Joensen: On the umbilical hernia in infancy (hernia umbilicalis infantum).
1. A short account of the umbilical region and hernias in this region is given. Variations in terms are mentioned and special attention is called to disagreements in view of the pathogenesis of the umbilical hernia of adult life (umbilical or paraumbilical).
2. Advanced etiological factors in infantile umbilical hernia and its dependence on birth weight, season and race are reported.
3. 4270 infants, born 1939—42 in Holbæk county medical district, Denmark, were examined by public health nurses about 15 times during the first year of life. 18,5 per cent of the infants demonstrated umbilical hernia. Sex exerted little influence on the frequency of umbilical hernia inasmuch as the boys exceeded the girls by only 2,3 percent. The sexual predominance is far more evident in small infants. Birth weight is of decisive import. The frequency of the umbilical hernia varies inversely with the birth weight of the infant. Very big infants demonstrate a slight tendency to more umbilical hernias than do infants with average birth weight (table 1).

Regular seasonal variations of the incidence of umbilical hernia could not be demonstrated (2. table, figure 1). Nearly all the cases of umbilical hernia, 90,7 percent, first appear in the 1. quarter of life, very few in the 3. and 4. quarter (3. table).

All cases of umbilical hernia with the exception of 7 were treated with application of a broad strip of adhesive plaster across the abdomen. According to the nurses the incidence of umbilical hernia after this treatment was only 1,17 per cent at the age of one year, in 0,39 per cent the result was unknown (4. table).

As there is no available group of children without plastertreatment, it is not possible to determíne the value of the applied treatment. Undoubtedly it is of great value, but the author supposes the incidence of umbilica hernia found by the nurses after treatment at the age of one year to be too low, compared with other statistics. He therefore personally has examined 104 children aged 2 to 6 year from the Queen Ingrid's kindergarten in Tórshavn and found only 2 cases of real umbilical hernia. The real frequency in properly strapped white infants at the age of one year therefore scarcely exceeds 5 per cent.

Of all cases of umbilical hernia about 85 per cent were cured by one continuous plastertreatment without any relapse before the age of one year. The others relapsed one or many times during the first year of life, but apparently only 6—9 per cent still persisted at the age of one year (5. table).

While high pressure in the abdomen and rachitis scarcely is of any importance as etiologic factors, these factors (bronchitis, pertussis and maybe rachitis) are of considerable import for the result of the treament and the relapse.

4. The suitability of surgical treatment of the umbilical hernia in childhood is diseussed, but it is concluded, that investigations on the pathogenesis of the umbilical hernia in adult life (umbilical or paraumbilical) and on the total disappearance or not of the sac in the infantile umbilical hernia still are to be performed to solve this problem.