An epigastric hernia occurs when tissue, typically fatty tissue, pushes through a weak spot in the abdominal wall, located in the midline of the abdomen. While often small, these hernias can lead to complications.
What is an Epigastric Hernia
An epigastric hernia forms when a small gap appears in the linea alba, a fibrous band of connective tissue running down the center of the abdomen. This allows underlying tissue, most commonly fat, to protrude. The resulting bulge typically appears in the upper central part of the abdomen, above the navel.
These hernias can be present from birth or develop later in life due to factors that strain the abdominal muscles. While some are very small, larger ones can reach the size of a walnut. The size of the hernia can influence whether it causes noticeable symptoms.
Common Signs and Symptoms
Many epigastric hernias do not cause symptoms and may go unnoticed. When symptoms occur, the most common is a visible bulge in the upper abdomen, especially when standing or straining. This bulge might disappear when lying down.
Individuals may experience a dull ache or sharp pain in the upper belly. This discomfort can worsen with activities that increase abdominal pressure, such as coughing, sneezing, or lifting heavy objects. Tenderness around the hernia site is also common.
When an Epigastric Hernia Becomes Dangerous
An epigastric hernia becomes dangerous if the protruding tissue becomes trapped, leading to two main complications: incarceration and strangulation. Incarceration occurs when the tissue within the hernia sac gets stuck and cannot be pushed back into the abdomen. Symptoms include increased pain, a firm or tender lump that cannot be reduced, and potentially nausea or vomiting if a portion of the intestine is trapped. Incarceration does not immediately cut off blood supply to the trapped tissue.
Strangulation is a more severe complication where the blood supply to the trapped tissue is cut off. This can lead to tissue death within hours if not addressed promptly. Signs include sudden, severe, and rapidly worsening pain at the hernia site, with the skin over the hernia appearing reddish, purple, or black. Other urgent symptoms can include fever, rapid heart rate, and signs of bowel obstruction, such as persistent nausea, vomiting, and an inability to pass gas or stool. Immediate medical attention is required for a strangulated hernia.
Treatment and Management
The management of an epigastric hernia depends on its size, symptoms, and complications. Small, asymptomatic hernias may be monitored.
Surgical repair is typically recommended for hernias causing symptoms, those larger in size, or those with a risk of complications. The goal of surgery is to return the protruding tissue to the abdominal cavity and strengthen the weakened abdominal wall. This often involves closing the defect with strong stitches, or for larger hernias, placing a synthetic mesh to reinforce the area and reduce recurrence.
If an epigastric hernia shows signs of incarceration or strangulation, emergency medical intervention is necessary. Addressing these urgent situations quickly can prevent serious health consequences, including potential tissue death or widespread infection. Surgery in these emergency cases aims to relieve the entrapment and restore blood flow to any compromised tissue.