Epigastric hernias occur in the midline between the xiphisternum and the umbilicus. These hernias are due to a small defect in the linea alba. A swelling may be visible and palpable which represents a small protrusion of pre-peritoneal fat through the fascial defect. The underlying fascial defect will be much smaller than the visible swelling. These hernias do not self resolve but can look less prominent as the child’s body shape changes. Some children may have more than one fascial defect.
These are common in childhood. Epigastric hernias are usually of cosmetic relevance only. It would be rare for such a hernia to cause abdominal pain or other symptoms.
Ultrasound scan is NOT required.
Special Considerations
Very rarely, the pre-peritoneal fat which has protruded through the fascial defect will become tender which may be due to venous congestion and potential ischaemia of the fatty tissue.
FM, LS, JB Sept 22
Who to refer:
- Children in whom there is uncertainty as to nature of an upper midline swelling or in whom the family wish to discuss surgery on cosmetic grounds.
- Children in whom an epigastric hernia is tender.
How to refer:
Referral is via SCI Gateway
Referral Priority
An asymptomatic supra-umbilical and epigastric hernia will be vetted as a routine referral.
Surgical Priority
Repair of supra-umbilical and epigastric hernia is a non-urgent procedure.
Options for Management in Primary care
- Simple reassurance.
- Ultrasound scan is NOT required.
