Umbilical hernia - At what point does it become dangerous?
March 29, 2017 | 21,00 EUR | answered by Nadja Struß
Hello.
For as long as I can remember, I have had a small umbilical hernia, which is about 0.5 x 0.7 cm in size. It can only be seen when looking into the belly button.
During my appendix surgery and afterwards, doctors have seen it and asked me about any pain. But since I don't have any, they advised me not to do anything about it.
Now I am about to embark on a long world trip and just thought about it again, and I am afraid of getting a piece of intestine trapped somewhere on a deserted mountain (exaggeratedly expressed).
Can anyone with experience say how and when such a navel hernia becomes dangerous?
Regarding mine: as described, it is very soft, can be pushed back in, when I cough forcefully it fills with a soft mass that can easily be pushed back in or held in place. When lying down and in many sitting positions, you can't feel any bulging or anything.
I know that I will eventually have to have it operated on, but when should I do it? When it starts to hurt or turn blue?
I would greatly appreciate a response.
Best regards
Dear inquirer,
You are describing an umbilical hernia, which is a gap in the abdominal wall, also referred to as a hernia gate. The hernia sac - the soft mass you describe that sometimes protrudes - is the peritoneum with parts of the intestinal loops or the so-called greater omentum (a kind of fatty apron that lies over the intestinal loops). When the intestinal loops are trapped in the hernia gate (this is a painful process), they are poorly supplied with blood, and over time the tissue can die. This can cause the intestinal bacteria, which normally live inside the intestines, to escape and infect the abdominal cavity.
Therefore, surgery is necessary when the intestinal loops are acutely trapped, as this is an emergency situation.
In your case, where the hernia sac can be easily pushed back and there is no pain, surgery is not necessarily required (this is referred to as "elective", meaning optional, not mandatory).
However, as an adult, the hernia gate will not close on its own. There is always a certain risk of strangulation. Even if you have not experienced any symptoms so far, you should consider surgery. As you mentioned, if you are traveling in remote areas and it happens there, it would be quite unfavorable, possibly even life-threatening, if prompt medical care is not available.
I would therefore recommend that you seek advice from a clinic specializing in visceral surgery (abdominal surgery) before your trip, preferably at a certified hernia center. You can find one near you online or inquire with your health insurance. Often, small hernias can be operated on under local anesthesia. However, if you wait and then need to be operated on as an emergency, it could potentially lead to a larger abdominal surgery.
I hope this information is helpful to you. If you have any further questions, feel free to write to me. But I consider it very important for you to see a hernia specialist in your situation.
Best regards,
Nadja Struß
