An epigastric hernia (EH) occurs when tissue, often fatty tissue, pushes through a small gap in the muscular wall of the abdomen. This protrusion happens in the upper central area of the belly, located between the breastbone and the navel. Epigastric hernias do not typically resolve spontaneously and may require attention if they cause discomfort or grow larger over time.
Identifying the Epigastric Region
The term epigastric refers to the specific anatomical zone where this type of hernia forms, also known as the epigastrium. This region spans the area from the bottom of the breastbone (sternum) down to the navel (umbilicus). It represents the upper portion of the central abdomen.
The hernia develops precisely along the midline of the body, a fibrous structure called the linea alba. This line is formed by the fused connective tissue where the two large vertical abdominal muscles, the rectus abdominis, meet. The epigastric hernia results from a defect or weakness in the fascia of the linea alba, allowing underlying contents to push outward.
Understanding this location is important because it differentiates the epigastric hernia from other types, such as umbilical hernias, which occur directly at the navel. The weak spot in the linea alba acts as a small opening through which tissue can protrude when internal abdominal pressure increases.
Physical Appearance and Characteristics
The most defining characteristic of an epigastric hernia is the visible lump or bulge it creates in the upper abdomen. These protrusions are generally small, often described as being the size of a pea or a marble, though some can grow as large as a walnut. They tend to be round or oval, presenting as a raised area along the central line of the body.
The consistency of the lump is usually soft to the touch, reflecting that the tissue pushing through the opening is most often pre-peritoneal fatty tissue. In some cases, a small piece of the peritoneum or a loop of intestine can be involved. The skin overlying the hernia typically appears normal in color and texture, showing no signs of irritation or discoloration.
A notable feature is the hernia’s reducibility, meaning the bulge frequently appears and disappears. The lump becomes more noticeable or prominent when abdominal muscles are contracted, such as when standing, coughing, or straining. Conversely, the bulge may flatten out and disappear completely when the person lies down or relaxes their abdominal wall.
While many individuals develop only a single epigastric hernia, multiple small defects can occur along the linea alba simultaneously. These multiple hernias present as a series of small, distinct lumps along the midline. The degree of noticeable bulging depends on the size of the defect and the amount of tissue that has pushed through.
Associated Symptoms Beyond the Bulge
While the physical lump is the primary sign, an epigastric hernia frequently causes non-visual symptoms. Many small hernias cause no discomfort and are discovered incidentally during a medical examination. When symptoms are present, they commonly include localized pain or tenderness directly at the site of the bulge.
This discomfort is often described as a dull ache, a pulling sensation, or a sharp, stitch-like pain, especially upon physical exertion. Activities that increase pressure inside the abdomen, such as heavy lifting, a prolonged cough, or straining during a bowel movement, can intensify the pain. This pain occurs because the protruding tissue is being compressed or irritated by the surrounding muscle and fascia.
A serious complication arises if the contents of the hernia become trapped, a condition known as incarceration. If the blood supply to the trapped tissue is cut off, the condition progresses to a strangulated hernia, which is a medical emergency. Signs of strangulation include severe, sudden, and rapidly worsening pain, often accompanied by nausea and vomiting. The skin over the hernia may also turn a dark reddish, purplish, or bluish color, indicating a lack of blood flow that requires immediate medical intervention.
Diagnosis and Management
A healthcare provider typically diagnoses an epigastric hernia through a straightforward clinical examination. During the exam, the doctor will inspect and palpate the upper abdomen, often asking the patient to cough or bear down to make the bulge more apparent. This physical assessment confirms the presence of the defect and determines if the hernia is reducible.
The provider may order imaging tests to confirm the diagnosis or evaluate the size and contents of the hernia sac. An ultrasound is a common, non-invasive imaging tool used to visualize the abdominal wall defect and the protruding tissue. Occasionally, a CT scan may be used for a more detailed picture, especially if the diagnosis is uncertain or if other internal issues are suspected.
Surgical repair is the standard and only definitive treatment for an epigastric hernia, as these defects do not close on their own in adults. The procedure, called a hernioplasty, involves pushing the protruding tissue back into the abdomen and closing the defect in the linea alba. For larger defects, the surgeon often reinforces the weakened area with a synthetic mesh to prevent recurrence.
The repair can be performed using an open technique, which involves a small incision, or a minimally invasive laparoscopic approach. Surgery is recommended for hernias that are causing pain, growing in size, or presenting a risk of strangulation. Most patients return home the same day, with recovery focused on avoiding heavy lifting for several weeks.