Ultrasonographic features of pediatric umbilical hernias ‒ associations with age, sex, and hernial orifice width

Abstract

Introduction and aim. Given the limited data on standardized ultrasound evaluation of hernial defect morphology in pediatric umbilical hernias, this study aimed to evaluate the ultrasonographic features of primary umbilical hernias in pediatric patients, with a particular focus on the width of the hernial orifice, the contents of the hernial sac and their potential correlation with age and sex. Material and methods. A retrospective analysis of medical records of pediatric patients with primary umbilical hernia who presented to the pediatric surgery outpatient clinic and had ultrasonographic measurements performed using a standardized protocol between 01.01.2024 and 31.07.2025. Results. Analysis of ultrasound measurements of the width of the hernial orifice width demonstrated a significant association between the width of the hernial orifice and the contents of the hernial sac. Children with intestinal loops present in the hernial sac were significantly younger than those with preperitoneal fat (p=0.016), and the width of the hernial orifice was greater in cases containing intestinal loops (p=0.028). In particular, among children with a hernial orifice larger than 14 mm, intestinal loops were observed more frequently than among those with an orifice width of 14 mm or less (58.82% vs 15.38%; p=0.026). Furthermore, the analysis revealed that the umbilical orifice was wider in boys than in girls (mean±SD: 15.44±1.64mm vs. 13.08±2.43mm; p=0.043).There was a difference between the width of the hernial orifice in children under 1 year of age and older. Conclusion. Ultrasonographic evaluation of pediatric umbilical hernias provides clinically relevant information on the morphology of hernial defects. In particular, the width of the hernial orifice is associated with the presence of intestinal loops in the hernial sac, especially in younger children, with a threshold value of >14 mm identifying patients at higher likelihood of intestinal content. These findings suggest that ultrasonography may contribute to risk stratification and support clinical decision-making in the management and follow-up of pediatric umbilical hernias.