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more urgently and a hernia that cannot be reduced should undergo immediate
surgical evaluation. Noncommunicating hydroceles often resolve spontaneously,
and given their more benign nature, can be observed as an outpatient.
Communicating hydroceles represent a patent tunica vaginalis and potential
hernia and therefore are repaired electively. Acute testicular torsion requires
emergent surgical reduction to reestablish blood flow to the testis prior to the
onset of necrosis (see Chapters 39 Inguinal Masses , 61 Pain: Scrotal , and 119
Genitourinary Emergencies ).
Umbilical Hernia
Umbilical hernias result when abdominal contents pass through an umbilical ring
that has not fully closed after birth. A common and frequently benign finding,
umbilical hernias often spontaneously resolve without intervention. Incarceration
of herniated bowel is a rare but serious complication that requires urgent
evaluation to preserve bowel integrity. Trisomy disorders are often accompanied
by laxity of abdominal wall and may be associated with umbilical hernias, as can
hypothyroidism. Surgical intervention is warranted if the hernia cannot be
reduced and/or shows signs of obstruction or incarceration. If the hernia persists
into early childhood, outpatient surgical repair may be recommended.

Umbilical Cord Anomalies
Goals of Treatment
The goal of treatment is to recognize and describe normal umbilical cord care,
and identify congenital cord anomalies, as well as acquired complications of the
umbilical cord.
CLINICAL PEARLS AND PITFALLS
Purulent or serosanguinous drainage from the umbilical stump may
represent omphalitis, which can proceed to life-threatening necrotizing
fasciitis if untreated.
Bleeding from the umbilicus can represent hemorrhagic disease of the
newborn or vitamin K deficiency.
Prolonged cord separation beyond 3 weeks can be a presenting sign of

leukocyte adhesion deficiency.
Normal Appearance of the Umbilical Cord Remnant