The clinical presentation in both children and adults are practically identical. Most common symptoms are abdominal discomfort and the presence of a painless bulge or swelling in the epigastrium [1]. This protrusion may be very small and may not be initially visible, but masses up 10 cm have been described [5]. The mass is usually reducible, which is a distinguishing feature across all types of hernias. Abdominal pain may be present together with nausea, while acute gastric outlet obstruction has been reported [9].

• Weakness

  More to Know A hernia is an opening or weakness in the wall of a muscle, tissue, or membrane that normally holds an organ in place. If the opening or weakness is large enough, a portion of the organ may be able to protrude through the hole. [akronchildrens.org]

  The surgeon will then strengthen the weakness in the abdominal wall that caused the hernia in the first place. A nylon patch or stitches are used to do this. [parkside-hospital.co.uk]

  Sometimes an epigastric hernia will form because of weakness in the abdominal wall after unrelated abdominal surgery. A congenital weakness in the abdominal wall can go completely undetected for years, and then appear as a hernia. [herniacenterlosangeles.com]

  Weaknesses can also occur in the abdominal wall later in life, especially after an injury or abdominal surgery. In men, the weak spot usually occurs in the inguinal canal, where the spermatic cord enters the scrotum. [mayoclinic.org]

• Swelling

  An epigastric hernia can usually be diagnosed simply by clinical examination, i.e. following inspection and palpation of the hernial swelling. The hernial swelling can often be reduced easily on lying down and the hernial orifice can be felt. [hernia-centre.com]

  Your child may have some swelling and bruising near the surgery area. Apply cool compresses (a cloth dipped in cold water, a freezer pack, or a bag of ice) to the area to reduce swelling. Wrap it in a towel to protect the skin. [kidshealth.org]

  September 1, 2003 A 48-year-old woman complained of dull, aching abdominal pain and epigastric swelling. She had a 6- to 7-month history of painless swelling that intermittently decreased in size. The patient denied vomiting and nausea. [patientcareonline.com]

  In this case report, we present a 64 years old woman with 6 days history of sudden onset of painful epigastric swelling associated with acute gastric outlet obstruction. We did not find a previous report of a similar case in the medical literature. [ncbi.nlm.nih.gov]

  The swelling should subside within a week. You may be able to resume normal activity, including sexual intercourse, in as little as a week, but it can take longer. [healthline.com]

• Surgical Procedure

  BACKGROUND: Repair for umbilical and epigastric hernia is a minor and common surgical procedure. Early outcomes are not well documented. [ncbi.nlm.nih.gov]

  procedure for your individual case. [londonhernia.co.uk]

  Acquired forms, on the other hand, may be induced by surgical procedures that directly cut through the linea alba. [symptoma.com]

• Fatigue

  CONCLUSIONS: There were no effects of an abdominal binder on pain, movement limitation, fatigue, seroma formation, general well-being, or quality of life. However, most patients claimed a subjective beneficial effect of using their abdominal binder. [ncbi.nlm.nih.gov]

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: January 31, 2019 [patientslikeme.com]

  You may also feel easily fatigued and "washed out" for a week or two following the surgery. These factors will put some limitations on your activity, but you will not cause any damage even if some soreness is experienced. [uhhospitals.org]

  The anesthesia may also leave you easily fatigued for a week or two. It wouldn’t be too surprising if you didn’t feel up to having sex for a while. [healthline.com]

• Weight Gain

  Reducing strain and intense pressure on the abdominal muscle wall is possible with a few lifestyle choices, including: Quitting smoking Maintaining a healthy weight Avoiding sudden weight gain Avoiding lifting objects that are too heavy for you Preventing [sharecare.com]

  Weight gain, fluid in the abdominal cavity, or even repeated strain from coughing can also cause epigastric hernias to form. Sometimes an epigastric hernia will form because of weakness in the abdominal wall after unrelated abdominal surgery. [herniacenterlosangeles.com]

  Acquired hernias may be caused by lifting heaving objects, extreme weight gain or persistent coughing. How is it treated? Whether your hernia is acquired or congenital, surgery is the only way to repair your hernia. [fixmyhernia.com.au]

  Additionally, avoiding sudden weight gain and heavy lifting in patients who are not advised to, such as pregnant women or those with recent abdominal surgery, is recommended. [symptoma.com]

• Cough

  In an older child, a hernia is likely to be more apparent when the child coughs, strains during a bowel movement or stands for a long period. [mayoclinic.org]

  Your doctor may also have you stand and cough in order to see the bulge more clearly as it comes out more when you coughing. [scnv.com]

  Tenderness or pain that does occur is often caused by pressure on the abdomen when lifting, bending, coughing, or straining the abdomen in other ways. The lump or bulge may be more noticeable when coughing or after eating a large meal. [sharecare.com]

  Passing through The defect in the linea in Pathogenesis of True Epigastric hernia in PATHOLOGY and TYPES of Epigastric Hernia Paramedian vessels and nerves Difference between True epigastric hernia and fatty hernia of linea alba No expansile impulse with cough [brainscape.com]

  A hernia of this kind can be caused by the weakening of the abdominal wall, coughing, straining on the toilet, heavy lifting, obesity, or a build up of fluid in the abdomen. [londonhernia.co.uk]

• Vomiting

  Nausea and Vomiting Nausea and vomiting are atypical symptoms of epigastric hernia. If nausea and vomiting occur along with increasing pain or fever, you should seek immediate medical care. [hellomotherhood.com]

  Thirty years before admission there was the onset of intermittent burning epigastric distress and vomiting associated with attacks of sharp right-upper-quadrant pain radiating to the interscapular region. [nejm.org]

  Nausea and vomiting are atypical symptoms of epigastric hernia. If nausea and vomiting occur along with increasing pain or fever, you should seek immediate medical care. Nausea and vomiting are signs of a serious complication of epigastric hernia. [livestrong.com]

• Nausea

  Nausea and Vomiting Nausea and vomiting are atypical symptoms of epigastric hernia. If nausea and vomiting occur along with increasing pain or fever, you should seek immediate medical care. [hellomotherhood.com]

  Nausea and vomiting are atypical symptoms of epigastric hernia. If nausea and vomiting occur along with increasing pain or fever, you should seek immediate medical care. Nausea and vomiting are signs of a serious complication of epigastric hernia. [livestrong.com]

  Nausea and Vomiting Nausea and vomiting can be mild and sporadic or severe. If a small part of the intestine gets stuck inside the abdominal tear, it may cause discomfort. Nausea may come and go, as the hernia protrudes and retracts. [justanswer.com]

  Nausea in pregnancy occurs in 91% of women in the first trimester, generally in the first 6 to 8 weeks. In its mild form, nausea is known as morning sickness. [emedicine.medscape.com]

• Diarrhea

  It found a twofold increased risk for general ear problems, a 77 percent increased risk for earaches and a 29 percent increased risk for diarrhea and other gastrointestinal illnesses among Read more [kaahe.org]

  If this occurs, Mary may also experience nausea, vomiting, diarrhea, and a fever. If any of these things occur, she needs to seek immediate medical attention. [study.com]

  Evaluation and management In patients with diarrhea longer than 48 hours in duration, profuse watery diarrhea, or diarrhea associated with rectal bleeding or weight loss, conduct a routine laboratory evaluation with stool studies for bacterial culture [emedicine.medscape.com]

  Some patients also find that they have diarrhea or "loose bowels" for the first days after their hernia repair — in the vast majority of cases, the bowel function normalizes with time. Constipation may also be common due to the pain medication. [uhhospitals.org]

  This gives birth to intense abdominal pain accompanied by nausea, diarrhea and vomiting. The site might appear blue or black. It is a medical emergency. Surgery is the only treatment. You must seek medical care immediately. [innovateus.net]

• Epigastric Pain

  […] symptoms * Examination Associated symptoms in CLINICAL PICTURE of Epigastric Hernia Dyspepsia and epigastric pain Pathogenesis of Dyspepsia and epigastric pain may be due to traction on the lesser omentum or the stomach Examination in CLINICAL PICTURE [brainscape.com]

  pain treatment Epigastric pain causes Disclaimer : The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. [practo.com]

  USMLE Step 3 prep: Which test for epigastric pain? A 36-year-old man comes to see you with recurrent epigastric pain after treatment for multiple duodenal ulcers, for which he was treated with a PPI, amoxicillin, and clarithromycin. [ama-assn.org]

  CASE: Sam’s wife gave birth to their 3rd child and mom and baby are discharged home seemingly well. 6 days postpartum, mom begins to experience epigastric pain. [hippoed.com]

  Fiebach, Lee Randol Barker, John Russell Burton, 2007 7 Differential Diagnosis in Primary Care Epigastric. Pain. [educalingo.com]

• Stroke

  It often is a delayed complication of ischemic stroke with no established standard effective treatment. OBJECTIVE: We present two cases of EPC; one with remote history of ischemic stroke (IS) and the other in the setting of subacute IS stroke. [n.neurology.org]

  The spectrum of this illness is vast and can range from mildly elevated blood pressures with proteinuria to full blown seizures with central nervous system collapse, increased intracranial pressure, pulmonary edema, liver failure, DIC and stroke. [hippoed.com]

  Among systemic brain disorders, mitochondrial diseases and non-ketotic hyperglycemia are particularly likely to cause EPC whereas stroke is a frequent cause of acute EPC. [ncbi.nlm.nih.gov]

  EPC in adults is sometimes linked to damage in the brain tissue from a stroke. [cedars-sinai.edu]

  • The outcome of epilepsia partialis continua is variable and is highly dependent on underlying cause: seizures are more likely to remit in patients with stroke or other acute insults than in patients with chronic encephalitis. [medlink.com]

The single most important step in the diagnostic workup is a thorough physical examination, since an initial diagnosis can be made solely on clinical grounds. Careful inspection and both superficial and deep palpation of the abdomen, with a particular emphasis on the epigastrium and the protracted bulge is essential, and a mass along the linea alba that is reducible when palpated is highly indicative of an epigastric hernia. To confirm the diagnosis, ultrasonography is considered as a simple and effective method, with sensitivity rates approaching 100% [5]. Other imaging studies, such as computed tomography (CT) may also be useful.

Although epigastric hernias are benign and self-limiting occurrences, they may cause discomfort and pain, which is why surgery is performed in virtually all patients, especially in larger forms. The goal is to alleviate discomfort and prevent further herniation through the abdominal wall by providing structural support. Initial approaches included a direct incision and reconstruction of the abdominal wall, but very high recurrence rates (11-20%) led to introduction of novel techniques [2] [8]. Mesh insertion at the site of protrusion has shown substantially lower recurrence rates, and more importantly, this technique was shown to be effective for management of larger and more voluminous hernias [5]. A laparoscopic approach has also been advocated because of very low recurrence rates and very quick recovery [13].

Epigastric hernias are not a life-threatening condition. In fact, 75% of all hernias are considered to be asymptomatic [1], whereas complications such as torsion and strangulation are rare. Incarceration of smaller hernias are common, however [1], but it is often benign and poses little risk. The prognosis may depend on the size and number (approximately 20-25% of epigastric hernias have multiple appearances) or hernias [1], and recurrence rates have shown to be up to 20% [12]. With the introduction of novel surgical methods, such as laparoscopy and insertion of a mesh, substantially lower recurrence rates have been observed [8].

The exact mechanisms that lead to development of epigastric hernia are unknown, but it is established that any weakness, tear, gap or opening in the rectus abdominis muscles on linea alba may lead to protrusion of a sac-like formation [1]. A proposed theory includes changes in decussation patterns of abdominal muscles and fasciae during embryonal development. Epigastric hernias develop between the xiphoid process and the umbilicus and are composed of peritoneal fat, blood vessels and viscera in some cases [1]. They may be present from birth, or they can appear in adulthood, in which case surgery and various predisposing conditions that induce increased intra-abdominal pressure are considered as causative agents [8].

Together with umbilical, incisional and inguinal types, epigastric hernia belongs to the group of ventral abdominal hernias, which are shown to be prevalent in up to 50% of the population [4]. Epigastric hernia alone, however, comprises 0.4-1.5% of all hernias of the abdominal wall [9], emphasizing its rare occurrence. Other reports suggest an overall prevalence rate of 3-5% in the general population [6], but not all patients are symptomatic and hernias may be quite small (15-25 mm) [5]. In children, studies have determined a prevalence rate of 4% across all types of hernias [10]. The diagnosis is most often made between 20-50 years of life and males are significantly more affected than females [1]. Namely, a 3:1 ratio was observed across various studies [1] [2], whereas others claim that the male/female ratio is not in disbalance [11]. Risk factors may represent any condition that puts extensive amounts of pressure on the abdominal wall, such as marked obesity, heavy lifting, ascites and chronic obstructive pulmonary disease (COPD).

Initial theories suggested deformities in the muscular sheaths and their decussation as the primary factor in the pathogenesis model [2]. Namely, the abdominal wall is composed of several aponeurotic and muscular layers that decussate with each other at the linea alba. It approximately 60-70% of individuals, these fibers decussate two or even three times, but in approximately 30-40%, this event occurs only once, thus creating a somewhat weaker spot on abdominal wall through which herniation may occur [2]. This phenomenon was considered to be the main pathological event in the onset of congenital forms of epigastric hernias. Acquired forms, on the other hand, may be induced by surgical procedures that directly cut through the linea alba [8]. Weakness of the abdominal muscles and conditions in which increased intra-abdominal pressure is seen, such as pregnancy [7], but also ascites, COPD, or severe obesity, are shown to be important determinants. Regardless of the cause, a sac-like formation protrudes through the anterior wall and carries fat, blood vessels and viscera in rare cases [1].

Little can be done in terms of preventing congenital forms of epigastric hernia, since factors that lead to its development are not entirely clear. The incidence of acquired forms, however, can be significantly reduced primarily by maintaining adequate strength and stability of abdominal muscles through regular exercise. Additionally, avoiding sudden weight gain and heavy lifting in patients who are not advised to, such as pregnant women or those with recent abdominal surgery, is recommended.

Epigastric hernias belong to the group of hernias that develop on the abdominal wall and occur due to weakness or openings of the abdominal muscles, usually as a result of congenital alterations in decussation of muscle fibers and fascia [1]. It appears on the linea alba and the location may include anywhere from the xiphoid process to the umbilicus [2]. Epigastric hernias are considered to be a rare entity in clinical practice, comprising between 0.35-1.5% of all abdominal hernias and only 8% of hernias that appear on the linea alba [3], but prevalence rates have been shown to be up to 50% according to certain reports [4], presumably because many patients have very small and asymptomatic hernias (15-25 mm) [5]. The majority of studies have determined that a significant predilection toward males exist, with a ratio of almost 3:1 [2]. The highest incidence rates were observed in individuals between 20-50 years [1], whereas cases in both children and pregnant women have been well-described [6] [7]. It is estimated that up to 75% of patients with an epigastric hernia may be asymptomatic [1], while abdominal pain, tenderness, gastric outlet obstruction and a visible and palpable reducible mass are main complaints. The initial diagnosis can be made solely on clinical criteria, whereas a confirmation can be obtained by simple ultrasonography, which has shown to be very effective [2]. Surgical treatment is necessary in virtually all cases and simple approaches such as direct reconstruction followed by suturing were considered as optimal approaches [2]. It is not uncommon for multiple hernias to be identified during ultrasonography and together with the fact that 20% of patients experienced recurrence with classical approaches [2], these facts led to the design of newer techniques, such as insertion of a mesh, resulting in significantly reduced recurrence rates [5]. Although this condition rarely poses any risk for the patient, significant discomfort and symptoms that may be misleading can appear commonly. For these reasons, early recognition through a meticulous physical examination will undoubtedly discover the origin of symptoms seen in epigastric hernia.

Epigastric hernia is a term that describes protrusion of the abdominal wall (herniation) in the epigastrium, the part that lies directly over the stomach. This form of hernia is rarely seen, comprising less than 2% of all abdominal hernias. It can be present from birth, when the presumable cause is malformations of the muscular and connective tissue layers in the midline of the stomach (linea alba), the principal site of its occurrence. Adult forms, on the other hand, can develop after surgical procedures or in conditions that cause increased intra-abdominal pressure. Obesity, ascites, chronic obstructive pulmonary disease (COPD) and pregnancy are all listed as potential risk factors. Epigastric hernia is most commonly diagnosed between 20-50 years of age and it is almost three times more commonly seen in males. Up to 75% of patients do not develop any symptoms, as hernias may be very small (1.5-2.5 cm), but larger protrusions may manifest with abdominal discomfort and pain, as well as nausea and stomach obstruction in rare cases. In virtually all patients, however, a visible bulge on the abdominal midline is observed with the naked eye, which is why physicians must inspect the abdomen in detail when patients are complaining of such symptoms. A distinguishing feature of epigastric (but also all other) hernias is their reducibility, i.e. they will retract on pressure. To confirm the diagnosis, ultrasonography is a simple and accurate imaging procedure, while computed tomography (CT scan) may be used as well. Despite the fact that this condition does not pose any risk for the patient, surgical treatment is indicated in order to reduce discomfort and further growth. Initial surgical approaches have yielded recurrence rates of up to 20%, which led to introduction of novel techniques such as laparoscopy and mesh insertion. The eventual goal is to provide structural support to the weakened part of the abdominal wall and through these approaches, recurrence rates are less than 1%. The single most important step in prevention of epigastric hernias is strengthening of the abdominal walls through regular exercise, whereas at-risk individuals, such as pregnant women, should avoid heavy lifting.

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