Epigastric Hernia

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

1. See Also
   1. Hernia
   2. Inguinal Hernia
   3. Inguinal Hernia in Children
   4. Sports Hernia
   5. Inguinal Hernia
   6. Femoral Hernia
   7. Umbilical Hernia
   8. Paraumbilical Hernia
   9. Incisional Hernia
   10. Spigelian Hernia
   11. Diastasis Recti
   12. Hernia Reduction
2. 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
3. Symptoms
   1. Epigastric Pain
   2. Pulling sensation on leaning backward
4. 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)
5. Differential Diagnosis: Epigastric Incarcerated Hernia
   1. Peptic Ulcer Disease
   2. Biliary Colic
6. 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
7. 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