Epigastric

• Point of weakness = the linea alba, anywhere between xiphoid process and umbilicus (through the upper midline)
• Anatomy:

  • Linea alba is a dense fibrous band which runs down the midline of the anterior abdominal wall from the xiphoid process to the pubic bone
  • Between the two rectus abdominis muscles
  • Epigastric hernias occur through a congenital or acquired defect in the upper part of the linea alba
• Aetiology and risk factors:

  • More common in men
  • Age 20-50
  • Anything that increases intra-abdominal pressure
  • Obesity is a key risk factor
• Clinical features:

  • Usually asymptomatic
  • Sometimes present with an upper abdominal lump that comes and goes and may be uncomfortable
  • Unlikely to cause bowel obstruction or ischaemia as usually only contain extraperitoneal fat (can still strangulate)
  • Hernia usually disappears when lying flat
• Management:

  • Asymptomatic - conservative management
  • Symptomatic - open repair with a mesh
  • Very small or women who plan to become pregnant - simple suture repair
• Type of ventral hernia