An epigastric hernia happens when a weakness in the abdominal muscle allows the tissues of the abdomen to protrude through the muscle. An epigastric hernia is usually present at birth, and may heal without treatment as the infant grows and the abdominal muscles strengthen.
An epigastric hernia is similar to a umbilical hernia, except the umbilical hernia forms around the belly button and the epigastric hernia is usually between the belly button and the chest.
An epigastric hernia is typically small enough that only the peritoneum, or the lining of the abdominal cavity, pushes through the muscle wall. In severe cases, portions of an organ may move through the hole in the muscle.
What is the epigastrium?
The epigastrium is the central, upper part of the abdomen which contains the following internal organs:
- Part of the stomach
- The duodenum (part of the lower intestine)
- The difference between this and the umbilical hernia is that the umbilical version occurs around the navel (belly button) whereas the epigastric hernia occurs a little higher up in the abdomen.
Who Is At Risk For an Epigastric Hernia?
Epigastric hernias are typically present at birth and may seem to appear and disappear, which is referred to as a “reducible” hernia. The hernia may not be noticeable unless the patient is crying, pushing to have a bowel movement, or another activity that creates abdominal pressure. The visibility of a hernia makes it easily diagnosable, often requiring no testing outside of a physical examination by a physician.
The causes of an epigastric hernia
This type of hernia often occurs at birth although it can develop in adults as well. With adults, it can be caused by an underlying weakness in the abdominal wall, lifting heavy objects, coughing, straining on the toilet, being overweight or a build up of fluid within the abdomen.
Symptoms of an epigastric hernia
There will be a noticeable lump in babies and very young children which is apparent when the child cries; has a bowel movement or moves in a certain way which puts pressure on the abdomen.
The hernia will appear and disappear at intervals –known as a ‘reducible’hernia but will not fix itself. Treatment in the form of surgery is required to do this and prevent the risk of a strangulated hernia.
If the hernia becomes tender to the touch, deep red in colour and is accompanied by nausea, vomiting and severe pain then emergency surgery is required.
If you have a child with a hernia then seek urgent medical attention if this develops into a strangulated hernia. This is a potentially dangerous condition and must be seen to as soon as possible.
Epigastric Hernia Treatment
An epigastric hernia will not heal by itself and does require surgery to be repaired. However, unless the hernia threatens to become an emergency, surgery can be postponed until the child is older.
Toddlers tend to tolerate surgery better than newborns, so it may be beneficial to wait before surgery is performed.
When Is Epigastric Hernia an Emergency?
A hernia that gets stuck in the “out” position is referred to as an incarcerated hernia. While an incarcerated hernia is not an emergency, it should be addressed, and medical care should be sought.
An incarcerated hernia is an emergency when it becomes a “strangulated hernia” where the tissue that bulges outside of the muscle is being starved of its blood supply.
This can cause the death of the tissue that is bulging through the hernia.
A strangulated hernia can be identified by the deep red or purple color of the bulging tissue. It may be accompanied by severe pain, but is not always painful. Nausea, vomiting, diarrhea and abdominal swelling may also be present.
Epigastric Hernia Surgery
Epigastric hernia surgery is typically performed using general anesthesia and can be done on an inpatient or outpatient basis. Special care should be taken to adequately prepare children for the surgery.
Surgery is performed by a pediatric general surgeon or a pediatric colon-rectal specialist.
Once anesthesia is given, surgery begins with an incision on either side of the hernia. A laparoscope is inserted into one incision, and the other incision is used for additional surgical instruments.
The surgeon then isolates the portion of the abdominal lining that is pushing through the muscle.
This tissue is called the “hernia sac.” The surgeon returns the hernia sac to its proper position, then begins to repair the muscle defect.
If the defect in the muscle is small, it may be sutured closed. The sutures will remain in place permanently, preventing the hernia from returning.
For large defects, the surgeon may feel that suturing is not adequate. In this case, a mesh graft will be used to cover the hole. The mesh is permanent and prevents the hernia from returning, even though the defect remains open.
If the suture method is used with larger muscle defects (approximately the size of a quarter or larger), the chance of reoccurrence is increased.
The use of mesh in larger hernias is the standard of treatment, but it may not be appropriate if the patient has a history of rejecting surgical implants or a condition that prevents the use of mesh.
Once the mesh is in place or the muscle has been sewn, the laparoscope is removed and the incision can be closed. The incision can be closed in one of several ways.
It can be closed with sutures that are removed at a follow-up visit with the surgeon, a special form of glue that is used to hold the incision closed without sutures, or small sticky bandages called steri-strips.
Recovering From Epigastric Hernia Surgery
Most hernia patients are able to return to their normal activity within two to four weeks. The belly will be tender, especially for the first week.
During this time, the incision should be protected during activity that increases abdominal pressure by applying firm but gentle pressure on the incision line.
Activities that indicate the incision should be protected include:
- Moving from a lying position to a seated position, or from a seated position to standing
- Crying — especially if the child turns red in the face from the effort
- Bearing down during a bowel movement