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Saturday, June 26, 2010

What else could an Umbilical Hernia Be?

As a Surgeon, every time I settle down and think to myself that I've seen a case like this before and it should be routine, God intervenes and reminds me that nothing in surgery is as it seems. Least of all when you expect it to be.

We had a lady who presented with a fairly simple small swelling just around her umbilicus at the lower edge. She had had it for about a year. She was keen on getting it out and got the relevant investigations for the surgery ready.

We took her into the O.T. and gave her the necessary sedation and local anaesthesia and proceeded with the usual 'smiling' umbilical incision. On dissection, we noticed a very well circumscribed localised blob of fat = Lipoma. Could it be?? As simple as a Lipoma? No way.

We dissected further. It wasn't extending beyond the subcutaneous plane. I had not even reached the rectus sheath and it was almost out. I was just about ready to call it a Lipoma and then I reached the rectus sheath. It seemed to be growing out of it. I had to really dig deep into my long forgotten medical school knowledge bank kept at the back of my head somewhere in the pits of my cerebrum.

I showed it to my senior. He confirmed. It was a 'Fatty hernia of the Rectus'. Strange, I thought. That's something I've heard in relation to the Linea Alba. Extraperitoneal fat in the epigastrium is known, but paraumbilical at the rectus?? Anyway, that's what we left it as since there was no sac, so it couldn't be a hernia and it was only fat and the defect was less than a cm in size.


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