Note 61 — Chapter LI · HERNIA.

A rare form of hernia into the umbilical cord has been described by Moran. It has been known as hernia funiculi umbilicalis, and has been held to be due to abnormal persistence of the vitelline duct, which holds the loop of intestine to which it was attached inside the abdominal wall, the intestine continuing to grow, the umbilical ring remaining open and the hernia thus enlarging. Occurring in this way it happens about the tenth week of fetal life. Such a hernia has no covering except the peritoneum and the amnion—i. e., is without muscle or skin covering. It would be probably first noted when the cord is about to be tied, when at its loop, as a translucent tumor, varying in size from that of a small cherry to a lemon, the cord being distended and assuming its own natural size only after it has left the hernial tumor. The bloodvessels will run on one side of the amniotic sac. Such sacs rupture easily, perhaps during crying efforts or even during parturition. The condition is serious, and when present no traction should be made on the cord. If easily reduced by taxis an antiseptic compress should be fastened over the opening. Should anything like strangulation occur operation is imperative and should be done immediately.