f Post graduate mcqs and discussion : EPIGASTRIC HERNIA (Fatty Hernia of Linea Alba)

Wednesday, March 28

EPIGASTRIC HERNIA (Fatty Hernia of Linea Alba)

 It is 10% common; common in males.

20% of epigastric hernias are multiple—Swiss cheese like.

It occurs usually through a defect in the decus sation of the fi bres of linea alba, any where between xiphoid process and umbilicus.

Extraperitoneal fat protrudes through the defect as fatty hernia of the linea alba presenting like a swelling in the upper midline with an impulse on coughing.

It is sacless hernia. Later protrusion enlarges and drags a pouch of peritoneum, presenting as a true epigastric hernia.


Fig: EPIGASTRIC HERNIA (Fatty Hernia of Linea Alba)

If the defect is less than 1.5 cm, lateral margin of the defect is formed by only anterior and posterior lamina of the rectus sheath; if the defect is > 1.5 cm, then lateral margin is also formed by rectus muscle.

 Content of true epigastric hernia is usually omen tum, some￾times it may be small bowel.

Common in muscular men; manual labourers.



Clinical Features


Often asymptomatic.
Swelling in the epigastric region which is tender.
Pain in epigastric region. It is often associated with peptic ulcer and so pain may be due to peptic ulcer. So gastroscopy is done to rule out acid peptic disease.

Impulse on coughing; defect in the epigastric region are also found.

Irreducibility, obstruction, strangulation as seen in any other hernia can also occur in epigastric hernia.



 Treatment


Through a vertical incision, sac is dealt with. Defect is closed with nonabsorbable interrupted sutures.

Large defect is supported with preperitoneal mesh.

Complete reconstruction of linea alba is needed from xiphi-sternum to umbilicus especially in Swiss cheese type using different methods like—interrupted primary closure using polypropylene sutures; modified shoelace technique is used after removing strip of medial margins of the linea alba; double breasting of the linea alba.