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What is an Epigastric Hernia?

By Caitlin Kenney
Updated Mar 03, 2024
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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.

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Discussion Comments

By anon925805 — On Jan 14, 2014

If you are overweight, would losing weight help for this specifically? Or once it is showing, you have to have the surgery?

By anon329249 — On Apr 08, 2013

I am 49 years old and my epigastric hernia developed during my first pregnancy 13 years back. It had greatly restricted my ability to do certain exercises at the gym and I was always so mindful of it.

Finally, I met with a surgeon who asked me why I hadn't repaired it to date and I replied, "I was too scared". His reply was, "I would be more scared of the consequences of not repairing it." That was enough for me and I decided last week to have the repair. I was scared to death but braved it out.

Let me tell you that this operation is so simple and my recovery is remarkable. I am bruised but without pain and am on no pain meds. I imagined so much worse. For those of you with this hernia, I encourage you to have the repair under controlled circumstances.

As the surgeon explained to, me a simple cough could cause it to tear heaps more and you can't control how much it will tear and than it becomes an emergency with large, painful incisions and possible organ implications. I'm four days post op and I am already able to drive and resume my exercising (no weights for four more weeks), but now wish I had made this decision years back.

The operation took five minutes and 29 seconds --nothing. I watched the operation on you tube as well so I understood that it is really just under your skin, like a splinter. Don't waste another moment pondering. Believe me, it was so easy, I am embarrassed by the fuss I had made previously.

By anon274976 — On Jun 14, 2012

My doctor told me that I would take my hernia to the grave, that there was no need to get it fixed. It doesn't hurt unless he keeps pushing in on it!

By anon179116 — On May 23, 2011

I am female age 50 and have had many different hernias since childhood. The first was an umbilical (repaired by surgery at age 10). Then many years later, I experienced several ops to repair an inguinal hernia which kept returning! Seven "repairs" and mesh inserted, problem solved!

More recently, I had noticed a swelling above the umbilical-scar, and was told this appeared to be a gastric hernia, but nothing to worry about. But now I am suffering regular intervals of pain and discomfort and wondering what home remedies (if any) could help?

By anon163789 — On Mar 29, 2011

I have just had surgery for an epigastric hernia. I am 66 and had stitches not mesh. No pain or discomfort, and the op went much better than I had thought possible.

Maybe I was lucky, but I would not put anyone off having the op.

By anon154035 — On Feb 19, 2011

i had my surgery re my hernia a few days ago, and if it was to be done again i would opt for it. the recovery is awful cannot move or anything hopefully it will improve soon

By anon142109 — On Jan 12, 2011

I am a retired police officer and have been recently been diagnose with a Epigastric Hernia. I have made arrangements to have elective surgery. I'm over 60 and in good health but nervous about the surgery. He is going to use a teflon type weave and is a very good specialist surgeon. Can I be awake for this procedure while he operates?.

By anon122417 — On Oct 28, 2010

I am a 37 year old female and first noticed my epigastric hernia probably eight years ago. I was concerned when I got pregnant that it would be problematic. Thankfully, that was not the case.

It does not seem to have increased in size but I have more tenderness on the edge of my abdominal muscles. And, I may choose to try to have another child and am curious if this type of hernia is often an issue in pregnancy or delivery.

By Charlie89 — On Jul 30, 2010

One good thing about epigastric hernias is that they are oftentimes small enough to suture closed, which can speed up healing time.

This can also be really beneficial to those with weak spots in their abdominal wall, as the sutured area will act as a reinforcement, preventing any future recurrence of a hernia.

By LittleMan — On Jul 30, 2010

Epigastric hernias are usually present at birth -- it is much rarer for them to present later.

In this way, it is similar to an umbilical hernia.

In fact, in many cases the hernia will heal on its own as the child grows older and its abdominal muscles get stronger.

By EarlyForest — On Jul 30, 2010

@anon39861 -- It's possible, although I think the only way it could happen were if the hernia was large enough to act like a bowel obstruction.

However, if that were the case, you would probably experience nausea and vomiting.

I would go to your doctor ask about it, he or she will tell you what's going on.

By anon39861 — On Aug 04, 2009

I've had this hernia for 3 years now. when I first noticed this hernia, my bowel movements seemed to change and have never quite changed back to normal. Could this hernia be why my bowel habits have changed?

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