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A 36 month old female presents for elective surgical repair of a small umbilical
hernia. Which of the following is the MOST IMPORTANT element of your
preoperative assessment in determining whether to proceed with the case?

a) Age of the patient

b) Family history of umbilical hernia

c) History of intestinal incarceration

d) Size of the hernia defect
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==Answer==
Answer c. In most patients umbilical hernias resolve spontaneously by age two
years. In the remainder, the usual course of treatment is delayed closure after
age 5 years in order to minimize the risk of anesthetic complications. Smaller
lesions are more likely to close spontaneously, but also more likely to result in
bowel incarceration and strangulation. Elective repair of umbilical hernias is
warranted for patients under age five who demonstrate symptoms of
incarceration in order to decrease the risk of bowel injury.
==Notes==
<references />
:This question originally printed in the [http://www.amazon.com/Justin-L.-Lockman/e/B00FLG5AEE/ref=ntt_dp_epwbk_0 Pediatric Anesthesiology Review Topics] kindle book series, and appears courtesy of Naerthwyn Press, LLC.
==Keywords==
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