Incarcerated Inverted Umbilicus in an 11-Year-Old Child

Abstract

We encountered an 11-year-old boy with no history of umbilical hernia. He visited our pediatric surgery outpatient clinic complaining that he had picked at his umbilical skin, inverting it, and had not been able to reduce it. His inverted umbilical skin was found to be congested. The outpatient doctor tried to reduce the umbilicus with the patient conscious, but this was impossible because of the pain he was experiencing. Thus, we performed reduction under general anesthesia. After the reduction, there was no hernia orifice in his navel. His postoperative course was good, and he was discharged the next day. Nine months after the reduction, he showed no recurrence. There has been only one report in Japan in which the umbilical skin turned inside out and became incarcerated. The mechanism is considered to involve the subcutaneous tissue of the inverted umbilical skin being strangulated between the umbilical edge and the scar tissue of the umbilicus, resulting in congestion. It is difficult to consciously invert the umbilical skin. However, in the present case, the patient reported a habit of pulling at the umbilical skin on a daily basis. This habit was considered to have caused the scar tissue of the umbilical fossa to be easily stretched, which contributed to the onset of inversion.