What is the most serious complication of an umbilical hernia in adults?

Strangulation is considered the most serious complication of an umbilical hernia in adults. This condition occurs when the blood supply to the herniated tissue is compromised due to the narrowing of the hernia sac. When the hernia becomes strangulated, the tissues within the hernia, often bowel, can become necrotic (tissue death) due to lack of blood flow. This not only poses a risk of infection but also leads to severe complications, such as sepsis and peritonitis, if not addressed promptly.

Incarceration, while a serious issue, refers to the entrapment of the herniated tissue without vascular compromise. It can lead to strangulation but does not inherently involve the immediate danger to the tissue that strangulation does. Perforation is a severe complication, but it is often a consequence of strangulated hernias where the compromised blood supply leads to bowel necrosis and subsequent perforation. Mesh infection, typically resulting from surgical repair with mesh, does not carry the same immediate life-threatening status as strangulation. Therefore, strangulation is the critical concern that highlights the urgency in managing umbilical hernias in adults.