more urgently and a hernia that cannot be reduced should undergo immediate surgical evaluation Noncommunicating hydroceles often resolve spontaneously, and given their more benign nature, can be observed as an outpatient Communicating hydroceles represent a patent tunica vaginalis and potential hernia and therefore are repaired electively Acute testicular torsion requires emergent surgical reduction to reestablish blood flow to the testis prior to the onset of necrosis (see Chapters 39 Inguinal Masses , 61 Pain: Scrotal , and 119 Genitourinary Emergencies ) Umbilical Hernia Umbilical hernias result when abdominal contents pass through an umbilical ring that has not fully closed after birth A common and frequently benign finding, umbilical hernias often spontaneously resolve without intervention Incarceration of herniated bowel is a rare but serious complication that requires urgent evaluation to preserve bowel integrity Trisomy disorders are often accompanied by laxity of abdominal wall and may be associated with umbilical hernias, as can hypothyroidism Surgical intervention is warranted if the hernia cannot be reduced and/or shows signs of obstruction or incarceration If the hernia persists into early childhood, outpatient surgical repair may be recommended Umbilical Cord Anomalies Goals of Treatment The goal of treatment is to recognize and describe normal umbilical cord care, and identify congenital cord anomalies, as well as acquired complications of the umbilical cord CLINICAL PEARLS AND PITFALLS Purulent or serosanguinous drainage from the umbilical stump may represent omphalitis, which can proceed to life-threatening necrotizing fasciitis if untreated Bleeding from the umbilicus can represent hemorrhagic disease of the newborn or vitamin K deficiency Prolonged cord separation beyond weeks can be a presenting sign of leukocyte adhesion deficiency Normal Appearance of the Umbilical Cord Remnant