Trust your hand

USG is very sensitive in identification of PPV, hernia sac and its content. If this is a hernia, I will operate, but not as an emergency.

It depends on the nature of the hernia, localization and size. Most small umbilical defects tend to close on the first months. Bigger defects might need surgery or the ones not closed in the first 4 years.

For inguinal hernias mostly are repaired electively, avoiding the risk of incarceration.

For umbilical hernias, its best to observe even for obvious protrusions. Inguinal hernias are however complicated. No obvious swelling with small USG detected hernias are frequent cause of concern to parents. A positive finding in USG is not as questionable as a negative finding, so I personally do not ask to repeat the USG by another radiologist.

It is sometimes difficult to convince the parents to have their newborns operated for something they have not identified as a threat yet. Therefore, I usually explain the parents some danger signs to look for and ask them to photograph or video the inguinal area when the child cries at home. Once you see/feel a bulge, all the decisions become easy.

I observe

Trust your clinical findings and follow up

não solicite um ultrassom desnecessario.

Ultrasound is operator dependent. Follow up clinically and if in doubt, seek second opinion.

For umbilical hernia i observe

For inguinal i operate

observe !