Epigastric hernia

Generality

The epigastric hernia consists in the escape of a bowel contained in the epigastrium . The epigastrium, or epigastric region, is one of the nine anatomical sections into which the abdomen can be divided; in particular, the epigastrium is located at the center and at the highest point of the abdominal region.

Its boundaries are: superiorly, the rib cartilages of the thoracic cage and, inferiorly, the umbilical region.

Caused by a collapse of the epigastric muscular wall, epigastric hernias are generally asymptomatic; only in rare cases, in fact, do they cause pain or lead to complications.

For a correct diagnosis, a physical examination is almost always enough, during which the doctor carefully visits the patient.

In the absence of severe symptoms or complications, epigastric hernia does not require any specific treatment; otherwise, doctors must intervene surgically.

What is a hernia

A hernia is the exit of a bowel and / or adjacent tissues (for example the surrounding fatty tissues) from the body cavity that normally contains them (NB: the word viscera indicates a generic internal organ).

The spill may be total or partial.

What is epigastric hernia?

An epigastric hernia is the escape of a bowel normally contained within the epigastrium .

In anatomy, the term epigastrium (or epigastric region ) identifies the highest and central area of the abdomen, bounded above by the costal cartilages and inferiorly by the umbilical region.

The internal organs, including in the epigastric region, are:

The pylorus. It is the terminal part of the stomach, in charge of regulating the entry of the gastric contents into the small intestine (ie the first part of the intestine). A valve, known as the pyloric sphincter, ensures an accurate passage of food between the stomach and intestines.
The duodenum. It is the first part of the small intestine; the latter also includes fasting and ileum.
Pancreas
Part of the liver
Part of the aorta
Part of the inferior vena cava
Transverse colon. It is the third section of the large intestine (or large intestine); it follows the cecum and the ascending colon, while it precedes the descending colon, the sigma and the rectum. The transverse colon is also the highest part of the large intestine.

The formation of an epigastric hernia can involve one of the above mentioned organs, but also the tissues of various nature (adipose in particular) that reside in the same anatomical region.

The nine abdominal regions

The epigastrium represents one of the nine anatomical regions with which the doctors describe the abdomen of the human being. Proceeding from left to right and from top to bottom, the other eight sections are: right hypochondrium, left hypochondrium, right lumbar region, umbilical region, left lumbar region, right iliac fossa, hypogastrium and left iliac fossa.

The epigastrium is located between the right hypochondrium and the left hypochondrium.

Epidemiology

The exact incidence of epigastric hernia is not known.

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Generally, this condition affects infants and very young children; however it is good to specify that it can arise in people of any age.

In adults, its appearance is often associated with obesity or pregnancy.

Causes

An epigastric hernia may form following a failure of the abdominal wall of the epigastrium.

To favor this failure can be:

The presence of a weak epigastric abdominal musculature . This condition is the main cause of epigastric hernia in infants and young children, who still have weak abdominal muscles.
With the physiological reinforcement of these muscles during growth, hernias with epigastric site and umbilicals tend to disappear naturally.
Repeated lifting of very heavy objects
Strong and repeated coughing
Excessive efforts in the toilet
Severe obesity
The presence of fluid inside the abdomen (ascites)
The state of pregnancy

RISK FACTORS

Obesity is a risk factor for the appearance of an epigastric hernia

According to the doctors, the main risk factors for epigastric hernia are obesity and pregnancy.

Symptoms and Complications

Epigastric hernia is often asymptomatic, ie it does not cause any particular symptoms.

In those rare cases in which it is symptomatic, it causes discontinuous pain at the level of the epigastrium ( epigastric pain ). Discontinuous pain means that the painful sensation comes and goes.

CLINICAL SIGNS

Generally, where the epigastric hernia is located, there is appreciable swelling to the touch and, only in some particular cases, also to the eye.

In infants and young children, for example, crying makes this protuberance visible.

COMPLICATIONS

Epigastric hernia is generally not a serious condition and / or one that requires medical attention.

However it can become one in two circumstances:

When it comes out of the abdominal wall is a portion of the intestine (for example the duodenum) and this herniated portion suffers an occlusion. The presence of an intestinal obstruction determines three characteristic symptoms: nausea, vomiting and pains (or cramps) in the stomach.
When the herniated (that is, escaped) bowel suffers a " constriction ". With the term "bottleneck", doctors identify the situation in which the herniated tract of the bowel no longer receives the correct blood supply. Without the right blood supply, the cells of the portion involved in the spillage undergo death (or necrosis), lack of oxygen and nourishment. Especially the duodenum, the "narrowing" of an epigastric hernia represents a medical emergency to be treated promptly.

WHEN TO REFER TO THE DOCTOR?

In adults, epigastric hernia becomes a condition that deserves medical attention when it causes severe pain (a symptom of a possible "choke"), nausea, vomiting, and / or stomach pains.

Diagnosis

To identify the presence of an epigastric hernia, an accurate physical examination is sufficient in most cases.

The latter requires the doctor to visit the patient, looking for any bumps at the epigastric level.

Due to the fact that epigastric hernia is often an asymptomatic condition, its identification often occurs randomly.

Treatment

Epigastric hernia requires specific treatment only when it causes severe symptoms and / or results in complications.

The specific treatment in question consists of a surgical repair of the abdominal epigastric wall, in order to replace the herniated bowel in the correct seat.

POSSIBLE SURGICAL APPROACHES

There are two possible surgical approaches:

Traditional or "open-air" . It is a somewhat invasive intervention method, which involves an incision on the abdomen (in the epigastric region) of several centimeters. Through this incision, the surgeon acts on the epigastric hernia, going to seal the leakage point.
Laparoscopic . It is a minimally invasive operative method, which involves the practice of two / three mini incisions (maximum one centimeter) on the abdomen. Through these small openings, the surgeon inserts the surgical instruments and accurately patches the abdominal wall that has yielded to the bowel.
To allow the hernia to be repaired without opening the abdomen, it is the use of a special instrument, called a laparoscope. In the end introduced into the abdomen, the laparoscope has a light source and a camera; the camera is connected to an external monitor, so as to allow the operating surgeon to "move" with confidence inside the abdominal cavity.

WHEN IN CHILDREN THERE IS NO SPONTANEOUS RESOLUTION

Sometimes, it may happen that infants and very young children with epigastric hernia do not heal spontaneously and need the aforementioned surgical treatment.

In such circumstances, and if there is no particular urgency, doctors prefer to postpone the surgery until the child is slightly older. The reason for this is related to anesthesia, towards which young children are not very tolerant. Therefore, the reasons for the postponement are purely precautionary.

TREATMENT FOR AESTHETIC REASONS

Sometimes, the epigastric hernia is such as to cause an unsightly protuberance. In such circumstances, even if the condition is totally asymptomatic, doctors may consider it appropriate to intervene surgically.