A hérnia umbilical (hérnia do umbigo) ocorre quando as camadas da parede abdominal não encerram completamente ao nível do umbigo e as estruturas intra-abdominais fazem saliência (saem) através desse ponto fraco. Ou seja, a hérnia umbilical ocorre numa zona de fraqueza das camadas da parede abdominal na região do umbigo, por onde surge a saliência.
Para além do umbigo, as hérnias podem surgir noutras regiões do abdómen, designando-se genericamente por hérnias abdominais. As hérnias também surgem, frequentemente, na região da virilha, designando-se neste caso por hérnia inguinal.
Por norma, os doentes que padecem de hérnias umbilicais podem levar uma vida perfeitamente normal e sem que ocorram complicações. No entanto, podem em alguns casos surgir complicações, algumas potencialmente graves, que sem tratamento atempado e adequado podem, em último caso, implicar risco de morte.
A hérnia umbilical é mais frequente na criança. Algumas estimativas referem que cerca de uma em cada dez crianças (10%) apresenta hérnia umbilical. A maioria das hérnias umbilicais encerra até ao final do primeiro ano de vida do bebé. Contudo, existem casos de hérnias umbilicais que demoram mais tempo a encerrar, sendo mesmo necessário em alguns casos efetuar tratamento cirúrgico. Veja mais informação em “tratamento” para melhor perceber quando operar a hérnia umbilical e que cuidados devem ser tomados.
Apesar de menos frequente do que na criança, este tipo de hérnia também afeta os adultos de qualquer idade, sendo mais frequente no sexo feminino do que no masculino.
Hérnia umbilical – causas
Nos adultos, a hérnia umbilical, geralmente ocorre quando há aumento da pressão abdominal. A presença de líquido intra-abdominal (ascite) causa aumento da pressão abdominal, sendo uma causa frequente de hérnias umbilicais.
Determinados fatores que provocam um enfraquecimento da parede abdominal podem também levar ao desenvolvimento das hérnias. O excesso de peso (obesidade), realização de esforços violentos, (como levantamento de objetos pesados no trabalho), algumas atividades desportivas intensas (como a musculação), a tosse crónica (tosse persistente no tempo, originada por algumas doenças pulmonares – DPOC, etc.), a obstipação, a cirurgia abdominal prévia, são exemplos de fatores de risco para o desenvolvimento da hérnia umbilical.
A gravidez é um fator de risco para a ocorrência de hérnias umbilicais, aumentando o risco com o número de gravidezes. As gravidezes multigemelares (gémeos, trigémeos, …) também aumentam o risco.
Algumas hérnias umbilicais não podem, infelizmente, ser prevenidas. Contudo, podem ser adotadas algumas medidas de prevenção que permitem reduzir os riscos de ocorrência de hérnias. Os adultos devem evitar o sedentarismo (praticar exercício físico), entre outras medidas que estimulem hábitos saudáveis.
Hérnia umbilical – sintomas
Nos adultos o sinal principal é uma saliência desconfortável, podendo até provocar dor na região umbilical. Por vezes, a hérnia pode ser bastante dolorosa.
Na criança, as hérnias umbilicais, por norma, não provocam dor, contudo a sintomatologia está muito dependente da gravidade da hérnia. Na infância, o ato de chorar, quando a criança tosse, fica mais agitada ou realiza esforços, podem agravar os sintomas. Por outro lado, quando a criança se deita ou acalma, os sintomas aliviam.
Hérnia umbilical – diagnóstico
O exame físico do abdómen demostra a hérnia, que se evidencia com aumento da tensão abdominal.
Se o conteúdo não puder ser reintroduzido no abdómen, diz-se que a hérnia umbilical está “encarcerada”. Esta situação é perigosa porque o conteúdo pode ficar sem irrigação sanguínea, falando-se então em “hérnia estrangulada”. Uma hérnia umbilical estrangulada é a mais temível complicação e requer tratamento urgente. Veja mais informação em “complicações”.
Para além do exame físico que é esclarecedor, o médico pode solicitar alguns exames de diagnóstico em casos especiais: pode ser feita uma radiografia, ecografia ou análises ao sangue, para melhor caraterizar a hérnia ou verificar se o intestino encarcerado está viável.
Hérnia umbilical – complicações
A complicação mais temível é o estrangulamento da hérnia. O estrangulamento ocorre quando não existe irrigação sanguínea da porção de intestino encarcerada na hérnia. Ou seja, o sangue não circula porque existe uma obstrução à sua passagem e ocorre necrose (o tecido morre). Devido à necrose, pode ocorrer uma inflamação / infeção da cavidade abdominal e peritonite, que em último caso pode levar o doente à morte.
Os sintomas de hérnia estrangulada são:
Febre;
Obstipação;
Dor abdominal intensa;
Náuseas e vómitos;
Saliência dolorosa no umbigo, com vermelhidão ou tom azulado.
Deve existir uma vigilância apertada, devendo consultar o seu médico em caso de suspeita de encarceramento ou estrangulamento da hérnia.
Hérnia umbilical tem cura?
Não existe qualquer tipo de tratamento médico que permita “curar” a hérnia umbilical. A única opção possível é realizar tratamento cirúrgico.
Pode optar-se por medidas de vigilância, sempre com o cuidado de prevenir possíveis complicações e desde que a hérnia não apresente sintomas que afetem de forma significativa a qualidade de vida do paciente.
Hérnia umbilical – tratamento
A maioria das hérnias umbilicais na criança acaba por encerrar naturalmente até aos 18 meses de idade, podendo em, alguns casos, encerrar de forma mais tardia. Se não ocorrer o encerramento até aos 3 anos de idade, se ocorrer dor, se a hérnia ultrapassar os 1,5cm de diâmetro ou existir o risco de encarceramento ou estrangulamento, então deve ser considerado tratamento cirúrgico.
Nos adultos, o tratamento cirúrgico permite resolver o problema e deste modo evitar possíveis complicações.
Alguns medicamentos podem ser prescritos para aliviar a dor (como o paracetamol, por exemplo).
Contudo, a única opção para resolver de forma definitiva o problema é realizar tratamento cirúrgico.
Hérnia umbilical – cirurgia
A cirurgia evita as complicações e pratica-se geralmente nas seguintes situações:
Hérnia dolorosa;
Diâmetro maior que 1,5 cm;
Ocorrência de encarceramento ou estrangulamento.
A cirurgia visa o encerramento da zona de fraqueza da parede muscular. Após a anestesia, a operação é feita de forma a recolocar o conteúdo da hérnia dentro do abdómen, encerrando-se o orifício com pontos. Em alguns casos, reforça-se a zona de fraqueza com uma prótese. A cicatriz que resulta após a cirurgia, depende da extensão da zona de fraqueza e da técnica cirúrgica utilizada.
Na atualidade, a intervenção por laparoscopia, realizada através da utilização de instrumentos cirúrgicos acoplados a uma câmara de filmar, permite em alguns casos realizar a operação de uma forma minimamente invasiva, através de pequenas incisões, reduzindo os riscos e as complicações.
A cirurgia é rápida e de baixo risco, exigindo um internamento de poucas horas e o doente pode reiniciar alimentação imediatamente. Durante uma semana deve evitar realizar atividade física.
Complicações da cirurgia
As complicações são pouco frequentes:
Infeção;
Recidiva ou reaparecimento da hérnia;
Ocorrência de dores de cabeça, náuseas ou vómitos;
Febre.
Recuperação, prognóstico
No pós-operatório é normal que surja alguma dor e edema (inchaço), que podem ser facilmente resolvidos com a prescrição de medicação analgésica / anti-inflamatória. Apesar de ser uma cirurgia de rápida recuperação e o doente poder regressar a casa após a cirurgia, deve ser mantido algum tempo de repouso, tipicamente pelo menos 2 a 3 dias, de modo a acautelar possíveis complicações.
Nas hérnias sintomáticas ou complicadas do adulto, a cirurgia é muito eficaz e a taxa de complicações e recidiva é muito baixa.
A atividade física normal pode ser retomada três semanas após a cirurgia.
Quando existe estrangulamento e a cirurgia é realizada rapidamente, o prognóstico é também ele excelente.
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