Doctors call an epigastric hernia a break in the upper abdominal wall between the navel and the lower end of the sternum. When fat and connective tissue penetrate from the abdominal cavity through the layers of the abdominal wall and a sack-like protuberance of the peritoneum forms a so-called hernial sac, this is a hernia. Epigastric means: relating to the upper abdomen (the epigastrium).
Epigastric hernias are comparatively rare. They only make up 5 percent of all hernias. Inguinal hernias (inguinal hernias) or umbilical hernias (umbilical hernias) are much more common.
In many cases, epigastric hernias go unnoticed because the fractures are either very weak or hardly any tissue from the abdominal cavity slides into the hernial sac.
When abdominal wall fractures cause discomfort, the fat and connective tissue of the large network, the so-called greater omentum, has often shifted. In rare cases, parts of the small intestine also enter the chest through an epigastric hernia. In these cases, severe upper abdominal discomfort usually occurs, which increases with pressure.
This pressure is usually built up from the inside, for example by carrying heavy loads. Persistent sneezing (for example with allergies), persistent coughing (for example with chronic lung diseases such as COPD) or strong pressure during bowel movements (especially with constipation) increase the pressure in the upper abdomen.
The bulging hernial sac is usually visible and palpable from the outside. In rare cases, acute epigastric hernias are accompanied by nausea, fever, or vomiting.
Complications arise when the tissue in the hernial sac of an epigastric hernia becomes twisted and disconnected from the blood supply. This is a medical emergency that requires immediate surgical treatment. If the trapped tissue dies, there is a risk of life-threatening infections of the chest or abdominal cavities such as peritonitis or pneumonia.
Small abdominal wall hernias without symptoms do not necessarily have to be operated on. A symptomatic epigastric hernia is usually treated surgically (fracture closure), as the risk of abdominal organs slipping into the chest increases over time. If the abdominal wall needs stabilization, a plastic mesh can be implanted, for example, which reliably closes the abdominal wall hernia.