An epigastric hernia occurs below the ribcage and above the navel along the midline of the abdomen. A hernia is a protrusion of a structure or tissue out of its normal position, usually through the abdominal wall. In the case of an epigastric hernia, fatty tissue and, rarely, intestines bulge through the linea alba beneath the ribcage. The linea alba is a strip of connective tissue visible as the depressed line that extends down the middle of the abdomen between the six pack muscles.
An epigastric hernia presents as a small bulge between the ribcage and the belly button that usually gets no bigger than the size of a golf ball. They are rarely found in regions other than the linea alba and are typically due to a congenital defect or weakness in the connective tissue or the abdominal muscles. Fatty tissue, intestines, or other structures may bulge through the weakness in the abdominal wall, but usually this type of hernia is small enough to only allow the peritoneum, or lining of the abdominal wall, protrude. This type of hernia is most common at birth.
An epigastric hernia is visible as a small bulge and is easily diagnosed in a physical examination. Other symptoms may include pain when pressure is created in the abdomen, for example if the patient is laughing, having a bowel movement, or crying. The hernia may be visible at some points and invisible at others. This is called a “reducible” hernia and means that the bulging tissue is pushing out of the weakness or hole and then falling back again. An incarcerated hernia occurs when the bulging tissue becomes lodged in the protruded position. This is a more serious condition, but not usually an emergency.
An epigastric hernia is typically not considered a medical emergency and treatment can usually be put off until the child is old enough to tolerate treatment. Unlike some other types of hernias, an epigastric one will not heal on its own and requires surgery. It can be a medical emergency if it becomes strangulated. This happens when an incarcerated hernia’s protruding tissue becomes cut off from blood supply, which can cause the death of the bulging tissue. A strangulated hernia presents with a dark red or purple color in the bulge, and sometimes severe pain, nausea, diarrhea, vomiting, and abdominal swelling.
Surgery for an epigastric hernia is performed by a general surgeon or a colon-rectal specialist, usually in pediatrics, since most epigastric hernia patients are young children. After giving the patient general anesthesia, the surgeon makes two incisions at the site of the herniation. Through one incision, the surgeon inserts a laparoscope, a viewing device that allows that doctor to see inside the abdomen without open surgery, and uses the other incision for all other instruments. The surgeon then pushes the bulging tissue back into its proper position.
The surgeon will then close and fortify the muscular or connective tissue defect. If the weak area is small, the doctor may close the hole with sutures that stay in place permanently to prevent the hernia from returning. If the weak area is large, the doctor will likely implant mesh. If there is suspicion that the patient will reject any surgical implants, the doctor may use sutures instead of mesh, but this will raise the risk of the hernia returning.