Umbilikal herni

Özet

Umbilikal herni, umbilikal halkadaki fokal fasya defektinden peritoneal kese içindeki omentum ve/veya bağırsak içeriğinin protrüzyonudur. Umbilikal kanal içinde yer alan preperitoneal yağ tek başına herni anlamına gelmez; BT’de fokal fasya defekti, kese-boyun ilişkisi ve içeriğin karın içiyle devamlılığı aranır. Bağırsak keseye hapsolduğunda geçiş noktası, proksimal dilatasyon ve perfüzyon bozukluğu acil komplikasyonları ortaya koyar. Göbek düzeyindeki normal yağlı kanalı gerçek herniyle karıştırmamak ve eşlikçi defektleri atlamamak için orta hattı çok düzlemli izlemek gerekir.

Faz ve pencere

Kontrastsız tanısal

Umbilikal halkada fasya kesintisi ve cilt altına uzanan yağ/omentum veya yumuşak doku yoğunluklu bağırsak ansı görülür; göbek cildi altında kese boynu izlenebilir. BT’de anatomik defekt, peritoneal kese ve kese içeriği morfolojik olarak değerlendirilir.

Portal tanısal

Bağırsak keseye girmişse duvar kontrastlanması, mezenter ve kese içi sıvı incelenir; azalmış kontrastlanma, mezenterik ödem veya sıvı ile kapalı ans görünümü iskemi/strangülasyon şüphesini artırır. Komplike herni şüphesinde BT, obstrüksiyonun derecesini ve bağırsak canlılığını değerlendirmede kullanılabilir.

Önerilen pencereler: Batın (G 400 / M 50), Yumuşak doku (G 400 / M 40).

BT bulguları

• Umbilikal halka defekti — orta hat fasya halkasının devamlılığı cilt altına açılan boyunda kesilir.
• Umbilikus arkasındaki yağlı kanal tek başına herni değildir. Gerçek umbilikal herni, umbilikal halkadaki fokal fasya defekti, peritoneal kese ve kese içeriğinin karın içiyle devamlılığıyla tanımlanır.
• Kese içeriği — gerçek umbilikal herni kesesi omentum ve/veya bağırsak ansı içerebilir; omentumun karın içindeki damarlarla devamlılığı izlenebilir.
• Boyun-içerik uyumsuzluğu — geniş kese içinde daha dar fasyal boyun, içeriğin sıkışma yerini tarif etmeye yarar.
• Obstrüksiyon şüphesinde keseye giren bağırsak segmenti ve tıkanıklığın derecesi BT’de değerlendirilir.
• İnkarserasyon/strangülasyon şüphesinde dar boyundan geçen bağırsak ansı, bağırsak duvarında azalmış kontrastlanma ve proksimal ince bağırsak dilatasyonu görülebilir.
• Umbilikus çevresindeki orta hat defektlerinin umbilikusa göre konumu belirtilir.
• Umbilikal herni defekti, umbilikal halka düzeyindeki fokal fasya kesintisiyle tanımlanır.

Normalde

Normal umbilikal seviyede linea alba ve umbilikal halka cilt ile karın boşluğu arasında kesintisiz ince fasya sınırı oluşturur; cilt altına çıkan yağ veya bağırsak kesesi bulunmaz. Göbek arkasında linea alba ile peritoneum arasında preperitoneal yağ içeren bir umbilikal kanal görülebilir; bu yapı, belirgin fasya defekti ve peritoneal kese içermemesiyle gerçek herniden ayrılır.

Ayırıcı tanı

Rektus diastazında linea alba genişler; bu bulgu tek başına fokal herni defekti anlamına gelmez ve eşlik eden umbilikal veya epigastrik herni ayrıca değerlendirilebilir.

Epigastrik ve umbilikal herniler ayrı ventral herni türleri olarak ele alınır.

Rektus diastazı

orta hatta rektus kasları ayrışmıştır ama tam kat fokal fasya deliği ve kese boynu görülmez.

Umbilikal bölge enfeksiyonu/apsesi

umbilikal pilonidal sinüsle ilişkili inflamasyon apseye ilerleyebilir; bir olguda BT’de umbilikal yumuşak doku dansitesi artmış ve visseral bağlantı görülmemiştir.

Urachus kalıntısı

fetal urachus doğumdan sonra median umbilikal ligament olarak kalır; umbilikal herni kesesinden farklı bir embriyolojik yapıdır.

Tuzaklar

• Umbilikus arkasındaki düzgün, yağ dolu umbilikal kanalı kese sayma; fokal halka defekti, peritoneal kese-boyun ve karın içiyle devamlılığı göster.
• Küçük yağlı çıkıntıda umbilikal kanal ile gerçek herniyi ayırmak için umbilikal halkadaki fokal fasya defektini, peritoneal kese ve kese içeriğinin karın içiyle devamlılığını değerlendirin.
• Umbilikal herni kesesi içindeki sıvıyı doğrudan strangülasyon kabul etme; bağırsak duvarı, mezenter, obstrüksiyon ve kontrastlanmayı birlikte tart.
• Eşlikçi paraumbilikal veya epigastrik aralığı ana umbilikal defektin parçası sayıp kaybetme; her fasya kesintisini ayrı anatomik konumlandır.
• Umbilikal kanaldaki yağlı görünümü herni olarak adlandırmadan önce umbilikal halkada fokal fasya defekti ve peritoneal kese bulunup bulunmadığını değerlendirin; kanal bu morfolojik özellikleri taşımaz.

Kendini dene

1. Umbilikal halka içinden cilt altına omentum uzanıyor; fasya boynu kesitlerde izleniyor. Tanı?

   • Umbilikal herni
   • Urachus kalıntısı
   • Rektus diastazı
   • Omfalit
   Cevabı göster

   Umbilikal herni. Umbilikal halka düzeyindeki fasya açıklığından dışarı uzanan omentum, kese boynuyla birlikte umbilikal herniyi gösterir. Urachus mesaneye uzanan kordon/kisttir; diastazda defekt yoktur; omfalit yumuşak doku inflamasyonudur.

2. Ventral orta hat defektinin merkezi umbilikal halkadadır. En uygun tanım hangisidir?

   • Epigastrik herni
   • Umbilikal herni
   • Spigel hernisi
   • Lomber herni
   Cevabı göster

   Umbilikal herni. Umbilikal halka düzeyindeki fokal fasya defekti gerçek umbilikal herni morfolojisiyle uyumludur.

İlgili konular

• İnsizyonel herni
• Spigel hernisi

Kaynaklar

Bu sayfadaki 41 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 21 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.