An epigastric hernia is a protrusion of fatty tissue or intestines below the rib cage and above the belly button, usually due to a birth defect or weakness in the abdominal muscles. It is visible as a small bulge and requires surgery as it will not heal on its own. Surgery involves inserting a laparoscope to push the protruding tissue into place and closing the muscle or connective tissue defect with stitches or mesh. If left untreated, it can become a medical emergency if the protruding tissue becomes strangled.
An epigastric hernia occurs below the rib cage and above the belly button 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, the intestines bulge across the linea alba below the rib cage. The linea alba is a strip of connective tissue visible as the linea depressa that extends down the center of the abdomen between the six pack muscles.
An epigastric hernia looks like a small bulge between the rib cage and 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 birth defect or weakness of the connective tissue or abdominal muscles. Fatty tissue, intestines, or other structures may protrude through weakness in the abdominal wall, but usually this type of hernia is small enough that only the peritoneum, or lining of the abdominal wall, can protrude. This type of hernia is most common at birth.
An epigastric hernia is visible as a small swelling and is easily diagnosed with a physical exam. Other symptoms may include pain when pressure builds up in the abdomen, such as if the patient laughs, has a bowel movement, or cries. The hernia may be visible in some places and invisible in others. This is called a “reducible” hernia and means that the protruding tissue is pushing out of the weakness or hole and then falls back again. An incarcerated hernia occurs when protruding tissue settles into a protruding position. This is a more serious condition, but is not usually an emergency.
An epigastric hernia is typically not considered a medical emergency, and treatment can usually be delayed until the child is old enough to tolerate treatment. Unlike other types of hernia, an epigastric hernia will not heal on its own and requires surgery. It can be a medical emergency if he gets strangled. This happens when the protruding tissue of an incarcerated hernia is cut off from the blood supply, which can cause the protruding tissue to die. A strangulated hernia presents as a dark red or purple color in the swelling and sometimes severe pain, nausea, diarrhea, vomiting, and abdominal swelling.
Surgery for an epigastric hernia is performed by a general surgeon or colorectal specialist, usually in pediatrics, as most patients with epigastric hernia are young children. After giving the patient general anesthesia, the surgeon makes two incisions at the site of the hernia. Through one incision, the surgeon inserts a laparoscope, a viewing device that allows the doctor to see inside the abdomen without open surgery, and uses the other incision for all other instruments. The surgeon then pushes the protruding tissue into its correct position.
The surgeon will then close and fortify the muscle or connective tissue defect. If the weak area is small, your doctor may close the hole with stitches that stay in place permanently to keep the hernia from coming back. If the weak area is large, your doctor will likely implant mesh. If there is a suspicion that the patient will refuse any surgical implants, the doctor may use sutures instead of mesh, but this will increase the risk of the hernia returning.
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