Umbilical Hernias Umbilical hernias are common in small infants, particularly in AfricanAmericans Fortunately, most of the hernias tend to close spontaneously, and only rarely does incarceration occur Umbilical hernias can be large and unsightly, and families need reassurance that watchful waiting is the best course However, if the umbilical hernia fails to close by the age of to years, surgical repair is indicated Umbilical hernias may be repaired earlier if there is a large ring that shows no signs of diminishing in size over to years, if there is a thinning of the umbilical skin, or if an incarceration has occurred Hernias that have a supraumbilical component tend not to close spontaneously and may be operated on at an earlier time of life Other Umbilical Defects Omphalomesenteric duct remnants may persist in either of two forms When the duct is patent from the ileum to the umbilicus, there is a release of small bowel contents via an opening in the umbilicus A second form involves a remnant of the omphalomesenteric duct that contains a secreting mucosal patch that is attached to an opening in the center of the umbilicus Passage of a sterile blunt probe or instillation of contrast dye under fluoroscopy via the umbilical opening will usually confirm either of these conditions Once identified, these remnants must be excised surgically In contrast, some infants present with umbilical granuloma in which an excessive amount of granulation tissue has built up after separation of the umbilical cord In these patients, no opening in the granulation tissue can be seen or felt by means of a probe These granulomas are usually best treated by application of silver nitrate to the granulation tissue After each treatment, the area should be rinsed thoroughly to prevent burning of adjacent skin If the granuloma is allowed to persist, it will eventually epithelialize and become an umbilical papilloma ( Fig 116.26 )