An infant with a bulge near the umbilicus that worsens with coughing is most consistent with which diagnosis?

• A. Umbilical hernia
• B. Diaphragmatic hernia
• C. Inguinal hernia
• D. Rectus sheath hematoma

Answer: (A)

In infants, a bulge at the umbilicus that worsens with coughing or crying is most consistent with an umbilical hernia. This happens when the natural opening at the umbilical ring fails to close properly after birth, allowing a portion of the abdominal contents to protrude through the navel. The bulge typically becomes more noticeable with increases in intra-abdominal pressure, such as crying, coughing, or straining, and is often soft and reducible. Many umbilical hernias in healthy babies close on their own as the abdominal wall strengthens, usually by age 3 to 5 years. In contrast, a diaphragmatic hernia would present with respiratory distress and a displaced heart or bowel in the chest, not a localized umbilical bulge. An inguinal hernia tends to present as a groin or scrotal swelling rather than at the umbilicus. A rectus sheath hematoma causes localized abdominal wall pain and tenderness, typically from trauma or strain, and does not present as a soft, reducible umbilical bulge that changes with coughing. If the bulge becomes nonreducible, painful, discolored, or is accompanied by fever, vomiting, or lethargy, urgent evaluation is needed for possible incarceration or strangulation.