Epigastric Hernia – Causes, Symptoms & Treatment
An epigastric hernia is a protrusion of tissue through a weakness in the abdominal wall between the navel and the breastbone. It often presents as a palpable lump and is treated surgically.
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An epigastric hernia is a protrusion of tissue through a weakness in the abdominal wall between the navel and the breastbone. It often presents as a palpable lump and is treated surgically.
What Is an Epigastric Hernia?
An epigastric hernia is a type of abdominal hernia that occurs in the epigastric region – the area of the upper abdomen between the navel (umbilicus) and the breastbone (sternum). In this condition, fatty tissue or, less commonly, abdominal organs push through a weakness or gap in the linea alba, the central fibrous band running down the midline of the abdominal wall. This typically results in a visible or palpable lump in the upper abdomen.
Epigastric hernias are the third most common type of hernia in adults and occur more frequently in men than in women. They can develop at any age but are most often seen in middle-aged adults.
Causes and Risk Factors
An epigastric hernia develops due to a weakness or defect in the abdominal wall. Contributing factors include:
- Congenital connective tissue weakness: Some individuals are born with a naturally weaker linea alba.
- Increased intra-abdominal pressure: Caused by chronic coughing, straining during bowel movements, heavy lifting, or intense physical exertion.
- Obesity: Excess body weight places continuous strain on the abdominal wall.
- Pregnancy: Stretching of the abdominal wall can create areas of weakness.
- Previous abdominal surgery: Scar tissue can reduce the structural integrity of the abdominal wall.
- Muscle weakening due to physical inactivity or aging.
Symptoms
Many epigastric hernias are initially asymptomatic or cause only mild discomfort. Common symptoms may include:
- A visible or palpable bulge in the upper abdomen, which may disappear when lying down
- Pressure or pain in the upper abdomen, particularly when coughing, sneezing, or exerting physical effort
- Nausea or a feeling of fullness after eating
- In rare cases: sudden, severe pain due to incarceration (trapping of hernia contents) – this is a medical emergency
Diagnosis
Epigastric hernias are usually diagnosed clinically through a physical examination. The physician palpates the bulge and assesses whether it is reducible (able to be pushed back). Imaging studies may be used to confirm the diagnosis or evaluate complex cases:
- Ultrasound (sonography): A quick, radiation-free method for visualizing the hernia
- Computed tomography (CT scan): Used for large or complex hernias to assess the full extent of the defect
- MRI (magnetic resonance imaging): Occasionally used as a supplementary diagnostic tool
Treatment
Watchful Waiting
Small, asymptomatic epigastric hernias may be monitored with regular medical check-ups rather than requiring immediate surgery. However, there is always a risk of incarceration of the hernia contents.
Surgical Treatment
The only definitive treatment for an epigastric hernia is surgical repair. There are two main approaches:
- Open surgery: Through a small incision in the upper abdomen, the hernia sac is reduced and the defect in the abdominal wall is closed – either by direct suture or by reinforcing the area with a synthetic mesh.
- Laparoscopic (minimally invasive) surgery: Using small incisions and a camera, the hernia is repaired from the inside. This approach generally allows for faster recovery and less postoperative pain.
The choice of technique depends on the size of the hernia, the overall health of the patient, and the experience of the surgeon. After surgery, a gradual return to normal physical activity is recommended.
Complications
Without treatment, an epigastric hernia may enlarge and lead to serious complications:
- Incarceration: Trapping of hernia contents with disruption of blood supply – a medical emergency requiring immediate surgery
- Strangulation: Tissue necrosis due to lack of blood flow to trapped contents
- Chronic pain and progressive decline in quality of life
References
- Muysoms, F.E. et al. - Classification of primary and incisional abdominal wall hernias. Hernia, 13(4):407-414, 2009. DOI: 10.1007/s10029-009-0518-x
- Townsend, C.M. et al. - Sabiston Textbook of Surgery, 21st Edition. Elsevier, 2022.
- European Hernia Society (EHS) Guidelines on the treatment of anterior abdominal wall hernias. Hernia, 2019. Available at: www.herniasociety.eu
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