UMBILICAL HERNIA

CASE PRESENTATION
NAME – SHAH SHAKSHI
4TH YEAR MBBS STUDENT
PARUL INSTITUTE OF MEDICAL SCIENCE AND RESEARCH , VADODARA,
GUJARAT
1. PATIENT DETAILS

• Name – Govind chandu Talaya

• Age - 60 years
• Sex – Male
• Religion - Hindu
• Occupation – Farmer
• Education – 8th std
• Address - Dabhoi Taluka
• Socioeconomic status – Low Socioeconomic status (SES)
2. CHIEF COMPLAIN
• Painful visible swelling on umbilicus since 2 years

3 . ORIGIN, DURATION AND PROGRESS – Ellaborating my origin , duration and

progress , patient was relatively asymptomatic before 2 years and came to
Parul Sevashram Hospital on 24-9-21 with a C/O of painful visible swelling on
umbilical region since 2 year which was gradual in onset and was like lemon
1*1cm size at first and slowly increased to present size 3*3cm and on doing
work, coughing it got increased in size and on lying down it stays at same size
and reduce by manipulating it and was having moderate dull aching pain not
radiating to thigh , back or any other region of body and was it was aggravated
on walking , working and relieved on lying down and was more on day time
than night due to work.
• Neagtive History – No fever
No nausea and vomiting
No distension of abdomen
No chest pain
4. PAST HISTORY
• No H/O of Diabetes mellitus , Hypertension and present illness in past
• No H/O of any surgery done on abdomen in past

5. FAMILY HISTORY – No significant family history

6. PRESENT HISTORY – Diet – Mixed
Appetite – Normal
Bowel – 3-4/day
Bladder – 4-5/day
Addiction- Smoking since 10 years
No alcohol intake H/O
No tobacco intake H/O
Summary of case – Presenting a case of 60 yr old male came with C/O painful visible
swelling on umbilicus since 2 years with smoking history of 10 years.​
7. PHYSICAL EXAMINATION
• After taking informed consent patient was examined via well light room
and adequate exposure
8. GENERAL EXAMINATION – Patient was conscious , well oriented to
time , place , person and self
* Vitals - Temperature – Normal measured by palpatory method
Pulse – 72/min measured on right radial artery by palpatory
method
Blood pressure – 120/80 mm hg measured on right brachial
artery by auscultatory method
Respiratory rate – 13-14/ min
• Head to toe examination
No pallor
No clubbing
No cyanosis
No generalized lymphadenopathy
No pedal edema
No skeletal deformity
No dehydration
No gait problem
• Neagtive History – No fever
No nausea and vomiting
No distension of abdomen
No chest pain
9. LOCAL EXAMINATION
• Done in standing and supine position and with exposed from umbilicus to mid thigh
• Inspection - A globular shaped swelling present over umbilicus of approx 3*3cm
with skin over swelling normal , surface smooth , well defined margin , with no
visible pulsation on swelling and around swelling , no distended veins on swelling ,
no peristalsis visible and blackish pigmentation seen on swelling and cough impulse
present
• Palpation – All inspectatory findings are confirmed on palpation
On doing palpation temperature was normal with no tenderness and with swelling
of 5*3cm size globular in shape with well defined margin , smooth surface , soft in
consistency with cough impulse present , swelling reduced manually with gurgling
sound and on checking for dripping effect while telling patient to elevate both legs
without folding 2 fingers defect was felt and compressible swelling.
• Percussion – Resonant sound felt and no ascitic fluid found on shifting
dullness
• Auscultation – On doing auscultation gurgling sound was heard on swelling
• 10. SYSTEMIC EXAMINATION
CVS- S1 N S2 HEARD
RS – Normal thocaroabdominal breathing seen with normal
respiratory rate.
Per rectal examination – DRE done and it was normal
CNS – Patient was consciouss and oreinted to surroundings and self
11. SUMMARY OF CASE
• Presenting a case of 60 yr old male came with a chief complain of
painful visible swelling on umbilicus since 2 years with history of
addiction of smoking present and on examination globular swelling
found of 5*3cm size with well defined margin , smooth surface , soft
in consistency with cough impulse present and swelling reducible and
compressible and gurgling sound present on both palpation and
auscultation leading to a provisional D/D of reducible umbilical hernia
containing intestine
• Points in favor - Swelling on umbilicus
Reducible , compressible
12. INVESTIGATIONS
• USG – Done to check for defect , fluid if present (to confirm asicites) ,to check for
content in sac
• Doppler – Done to check for vascularity
• Other Ix like CBC, Glucose, LFT, RFT, etc. Done for anesthetic purpose
• 13. MANAGEMENT -
1. Conservative Mx –1. If infant and less than 2cm than wait for 2 years as defect
will get close by itself and if not than operate(>2cm)

2. Surgical Mx – 1.For adult if >2cm , go for open sx and if small defect laparoscopy
can be done and mesh can be put
2. Mayo's repair for umbilical hernia with double breasting of rectus muscle.
THANK YOU
4. PAST HISTORY
• No H/O of Diabetes mellitus , Hypertension and present illness in past
• No H/O of any surgery done on abdomen in past

5. FAMILY HISTORY – No significant family history

6. PRESENT HISTORY – Diet – Mixed
Appetite – Normal
Bowel – 3-4/day
Bladder – 4-5/day
Addiction- Smoking since 10 years
No alcohol intake H/O
No tobacco intake H/O
Summary of case – Presenting a case of 60 yr old male came with C/O painful visible
swelling on umbilicus since 2 years with smoking history of 10 years.​