Epigastric Hernia

Aka: Epigastric Hernia, Hypogastric hernia, Fatty Hernia of the Linea Alba

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II. Pathophysiology

  1. Type of Ventral Hernia
  2. Consists of properitoneal fat (rarely peritoneal sac)
  3. Location
    1. Occurs through linea alba (midline)
    2. Occurs below xiphoid process and above Umbilicus

III. Symptoms

  1. Epigastric Pain
  2. Pulling Sensation on leaning backward

IV. Signs

  1. Difficult to detect in obese patients
  2. Frequently presents as Incarcerated Hernias of preperitoneal fat
    1. Bowel incarceration or Strangulation is rare
  3. Examine patient in standing position
    1. Run finger down course of linea alba
    2. Detects small midline Nodule
    3. Hernias are typically small (<1 cm)

V. Differential Diagnosis: Epigastric Incarcerated Hernia

  1. Peptic Ulcer Disease
  2. Biliary Colic

VI. Management: Surgery

  1. Suture closure of defect
  2. Multiple Epigastric Hernia defects often exist
    1. Adequate linea alba exposure required
    2. Surgeons explore for occult Hernias

VII. References

  1. Goroll (2000) Primary Care Medicine, p. 431-433
  2. Degowin (1987) Diagnostic Examination, p. 489-96
  3. Stevens (2013) Crit Dec Emerg Med 27(9): 2
  4. Townsend (2001) Sabiston Surgery, Saunders, p. 797

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