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Answer: Epigastric Hernia

  • A defect in the linea alba between the xiphoid process and the umbilicus. Comprise only 1-5% of all hernias.
  • It is rare for these to have bowel in them or to incarcerate and contain only preperitoneal fat on most occasions. They can be singular or multiple.
  • They may be symptomatic or enlarge and it is now recommended by most surgeons that they should be closed and not left to resolve on their own.
  • Timing of the surgery for non symptomatic or non enlarging  epigastric hernias is not absolute, as some experts recommend repair within months of discovery and others recommend surgery be postponed in infants until they are toddler age.

Nelson Textbook of Pediatrics, Nineteenth Edition Robert M. Kliegman, Bonita F. Stanton, Joseph W. St. Geme, Nina F. Schor, and Richard E. Behrman Chapter 364, 1418-1414.e3

Presentation and management of epigastric hernias in children. J. Pediatric Surg, 2000 Dec; 35(12):1754-6 Coats RD, Helikson MA, Burd RS

Past diagnoses

Eczema herpeticum

An association of atopic dermatitis and HSV infection

Eczema HerpeticumEczema herpeticum presents as vesicular lesions in areas of pre-existing atopic dermatitis 10 days after exposure to HSV. The lesions progress to pustules and are markedly umbilicate. Secondary Staphylococcal super-infection is common.  High fever and adenopathy in 2-3 days of illness can be observed. Eczema herpeticum is a medical emergency in a young infant as viremia and internal organ dissemination can be fatal. Recurrence is uncommon and usually mild.
Management:

  1. Acyclovir 25 to 30mg/kg/day oral OR Acyclovir 1500mg/m2/day IV in three doses.
  2. Anti-staphylococcal  antibiotics
  3. Cool wet compresses over the lesions

Iris coloboma

Iris colobomoaA coloboma is a hole in one of the structures of the eye. This can occur in the eyelid, iris, retina, choroid or optic disc.  It is present at birth and can be caused when a gap present between two structures in the eye of the fetus fails to close up completely before birth. This can be an isolated defect or part of CHARGE syndrome (coloboma, heart defects, atresia choanae, retardation of growth or development, genito-urinary anomalies, and ear anomalies.)

Reference: McInerny TK, Adam HM, Campbell DE, Kamar DM, Kelleher KJ, eds. American Academy of Pediatrics Textbook of Pediatric Care, Elk Grove Village IL: American Academy of Pediatrics, 2009