Epigastric Hernia
Most babies have a relatively wide space between the muscles that run up and down the anterior abdominal wall (rectus muscles). This space consists of a type of tissue that gradually continues to strengthen and ultimately results in these muscles coming together in the middle of the abdominal wall. As this process continues, there is occasionally a weak point in this fascia, known as the linea alba, that may result in a piece of fatty tissue underneath popping through and causing a lump. The lump is always in the middle of the abdominal wall and often is completely free of any symptoms. It usually does not change in size and, under most circumstances, is found by the mother or father during bathing or by a pediatrician during a well-baby visit.
What can I expect regarding care?
These masses usually result in referral to a pediatric surgeon for evaluation. After a simple office examination and the child's medical history, process of the development of this particular problem, as well as other options as to what might actually be causing the bulge, are usually reviewed. In most circumstances, especially when the size doesn't change and the bulge is not tender to the baby, the recommendation is either observing the bulge for gradual resolution or a brief operative procedure. In cases where the bulge changes in size or causes the baby pain, surgical repair is considered the most appropriate course.
How is it corrected surgically?
The process is simply a matter of a small incision over the area of the bulge once it is localized and then removal of the piece of fat with closure of the defect through which the fat protruded.
What complications should I expect?
As with all operative procedures, the most common complication is potential for infection of the surgical site. While bleeding is a possibility, there are no blood vessels in and around this area that if cut would cause bleeding or any potential threat to the child's life. The other problem is persistence of a palpable lump that is the result of the fascial repair causing some scarring or the possibility of a second bulge occurring in the nearby area. Occasionally, parents become concerned by a bulge caused by the suture used to close the defect. This gradually goes away as the suture begins to dissolve.
What kind of follow-up care is required?
These children are very similar to those who undergo umbilical hernia repair and usually require a single postoperative visit to confirm complete healing of the skin incision.
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