Epigastric hernia

An epigastric hernia is where fat pushes out through a weakness in the wall of your abdomen between your umbilicus (belly button) and sternum and forms a lump

1. Epigastric hernia ( synonym: fatty hernia of the linea alba)

2. Anywhere between the xiphoid process and the umbilicus, usually midway. P rotrusion of extraperitoneal fat through the linea alba- site where small blood vessels pierced the linea alba(minority). More likely that the defect occurs as a result of a weakened linea alba due to abnormal decussation of the fibres of the aponeurosis . C ommon cause of ‘recurrence’ is failure to identify a second defect at the time of original repair.

3. A swelling the size of a pea(<1cm) -protrusion of extraperitoneal fat only E nlarges , it drags a pouch of peritoneum after it The mouth of the hernia is rarely large to permit a portion of hollow viscus to enter it ; So, Either the sac is empty or it contains a small portion of greater omentum . It is likely that an epigastric hernia is the direct result of a sudden strain tearing the interlacing fibres of the linea alba.

4. The patients are often manual workers between 30 and 45 years of age.

5. Clinical features Symptomless: A small fatty hernia of the linea alba can be felt more easily than it can be seen and may be symptomless, discovered only in the course of routine abdominal palpation . DDx : Lipoma Painful: Sometimes such a hernia gives rise to attacks of local pain, worse on physical exertion, and tenderness to touch and light clothing. This may be because the fatty contents become nipped sufficiently to produce partial strangulation . Referred pain: It is not uncommon to find that the patient, who may not have noticed the hernia, complains of pain suggestive of a peptic ulcer. However , as the majority of these hernias are asymptomatic, symptoms should not be ascribed to the hernia until any gastrointestinal pathology has been excluded.

6. Treatment Very small – disappear(infarction) Small to moderate - If the hernia is giving rise to symptoms, operation should be undertaken.

7. Operation (open or lap) An adequate vertical or transverse incision is made over the swelling, exposing the linea alba. The protruding extraperitoneal fat is cleared from the hernial orifice by gauze dissection. If the pedicle passing through the linea alba is slender, it is separated on all sides of the opening by blunt dissection. After ligating the pedicle, the small opening in the linea alba is closed with non-absorbable sutures in adults and with absorbable sutures in children. When a hernial sac is present, it is opened and any contents reduced, after which the sac neck is transfixed and the sac excised before repairing the linea alba. If smaller protrusions of fat are found above or below the hernia, these should also be dealt with. If the hernia is large (defect greater than 4 cm diameter), the repair should be reinforced with polypropylene mesh positioned in the retromuscular plane