Epigastric hernia
- Protrusion of extraperitoneal fat / peritoneal contents through a small defect in the linea alba
- Usually halfway between xiphoid process and umbilicus
- Usual presentation
- Commonly confused with upper GI pathology
- Epigastric pain which may increase after meals
- May be acutely painful after physical exercise
- Nause and early satiety
- Reflux and non-ulcer dyspepsia
Approach
- Expose abdomen
- Inspect
- Lump may appear when asking patient to lift head off bed
- Ask patient to cough to see if this becomes more prominent
- Palpate
- Can be difficult to find the hernia
- Try to identify the borders of the defect and the size of the neck
- Percuss
- Auscultate
Completion
- Complete the abdominal examination
Treatment options
- Non-surgical
- Surgical (site should be marked with patient lying supine)
- Excise sac
- Repair defect