What are the symptoms of an epigastric hernia?

• Epigastric hernia is a defect in the abdominal wall above the navel. Tissue can protrude through this defect into the abdominal cavity, forming what is known as a hernia.
• The main symptom of an epigastric hernia is the protrusion of a mass in the upper abdomen, which may or may not be painful.
• The definitive solution to remove an epigastric hernia is surgery, whereby the hernia sac is reinserted and the damaged abdominal wall is closed.

Before we know what an epigastric hernia is, we must be clear about what an abdominal hernia is.

An abdominal hernia is the projection outwards of part of the tissue inside the pelvic-abdominal cavity forming a visible and palpable bulge due to a defect in the inner wall of the abdomen.

When we speak of epigastric hernia, we refer to the type of abdominal hernia that appears in the midline, i.e. between the lowest part of the sternum and the navel.

In the area of the abdomen above the navel, the aponeurotic fibres (a type of tendon) are cross-linked, which means that this area of the abdomen is stronger. However, in people with an epigastric hernia, the cross-linking of these fibres is not uniform and is more separated, making the area more likely to tear.

This cross-linking of aponeurotic fibres is congenital in origin, so if they are not well formed, they will weaken over time to form the hernia. 

In any case, although the main factor in the appearance of an epigastric hernia is congenital deficiencies, the weakening and pressure of the abdominal wall play an important role in its formation:

• Weakening of the abdominal wall, which can occur due to excessive weight lifting, heavy physical exertion, pregnancy, ageing, overweight and in general, anything to do with any activity that increases the pressure on the abdominal tissue.
• Weakening of the abdominal walland subsequent tearing due to a previous surgical incision.

Epigastric hernias occur in approximately 5% of the population and are more common in men than in women and in young and middle-aged adults.

The bulging of the area between the umbilicus and the sternum is the most common symptom and the one that allows the diagnosis of hernia. It should be borne in mind that when there is a defect in the abdominal wall, a kind of pouch or sac comes out, which is perceived as a bulge in the area. 

This bulge may become more evident when the patient makes an abdominal effort.

The hernia may not show symptoms of pain, which does not mean that it should not be checked by a specialist and require surgery to avoid future complications (incarcerated or strangulated hernia).

The time when the patient feels pain is usually when the hernia forms or increases in size due to added strain on the area.

At later stages, when the hernia is already in place, the pain is milder, which makes it easier for the patient to tolerate and even get used to it.

It is important to surgically repair epigastric hernia before complications occur as these may require emergency surgery and lead to intraoperative complications.

Symptoms of an incarcerated epigastric hernia

The main symptom of an incarcerated epigastric hernia is that it cannot be reduced manually. Initially, this is the only complication, although there are usually significant episodes of pain that may require emergency surgery.

Similarly, an incarcerated epigastric hernia has a good chance of becoming strangulated if part of the small intestine gets into the bulge and, due to the pressure exerted by the hernial ring on it, there is a lack of blood supply that can lead to tissue necrosis, which will require emergency surgery.

Other symptoms of an epigastric hernia

Because of the partial obstruction of part of the intestine protruding into the hernia sac, the patient may suffer from constipation due to difficulty in passing stool.

To determine whether it is an epigastric hernia, the specialist, whether in primary care or general surgery, will mainly carry out two processes, the medical interview (anamnesis) and the physical examination.

During the anamnesis, the specialist asks the patient what symptoms they have and their feelings about the problem they are concerned about. Thanks to this, the specialist will rule out other pathologies and proceed to perform a physical examination to make a definitive diagnosis.

During the physical examination, the specialist will determine whether it is an epigastric hernia and, if so, whether it can be reduced manually or whether it is incarcerated. If the hernia is found to be strangulated, you will be referred directly to surgery for an emergency operation.

In all cases, the only solution to relieve the symptoms and avoid the complications mentioned above is epigastric hernia surgery.

As mentioned above, the only definitive treatment is surgery. Below we explain the two types of hernia surgery that exist:

• Hernioplasty: With this technique, the surgeon reintroduces the hernia sac into the abdomen and then places a mesh of synthetic material in the damaged part of the abdominal wall.
• Herniorrhaphy: This consists of the placement of stitches by the specialist in the area of the abdominal wall that is damaged, thus closing the hernial defect.

In some asymptomatic cases, epigastric hernia can be left untreated, although this is not recommended, as it will eventually grow and can lead to further complications. Epigastric hernia surgery significantly increases the patient's quality of life, avoiding long-term complications and completely eliminating the symptoms. It also corrects the aesthetic aspect that the hernia may have caused.