Incarceration of umbilical hernias in children: a rare but important complication

Umbilical hernia (UH) is a common condition in infants and young children, especially in those of Afro-Caribbean origin. Spontaneous closure occurs in a majority of cases before the age of 4 years unless the neck of the sac i s greater than 2 cm in diameter. Complications are rare, and conservative m anagement is therefore advised during this time. We present three cases of incarcerated UH in boys under 4 years old, all of whom presented with small -bowel obstruction. Interestingly, in two of them undigested vegetable matt er in the small bowel appeared to have precipitated the obstruction. A surv ey of the literature suggests that the incidence of this complication is ap proximately 1:1,500 UHs. We conclude that the present policy of expectant m anagement is safe for the vast majority of children, but parents and genera l practitioners should be aware of the small risk and early symptoms of inc arceration.