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Herniated belly button of 3 month old baby.

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A radiograph of the chest and abdomen reveals a left congenital diaphragmatic hernia with loops of bowel (arrow) in the left hemithorax, displacing the heart and mediastinum toward the right. This type of hernia, a Bochdalek hernia, occurs in the posterolateral diaphragm and is more common on the left. Today, most cases are diagnosed with fetal imaging.

The patient was born with an omphalocele that could not be completely closed at birth. Over time, the patient developed a large abdominal wall defect as a sequela, clinically behaving as a complex ventral hernia.

Preoperative Protocol:

• The patient underwent evaluation by a multidisciplinary complex abdominal wall team.
• Preoperative abdominal CT scan demonstrated a large ventral defect with loss of domain.

Surgical Treatment:

• Definitive surgical management consisted of abdominal wall reconstruction with primary fascial closure using RTL technique (reinforcement tension line).

AP radiograph (image 1) and axial contrast-enhanced CT (image 2) show large bilateral inguinal hernias (arrows) containing bowel. Indirect inguinal hernias, the most common type in neonates, result from a patent processus vaginalis and are treated surgically to repair the defect.