Epigastric Hernia

[Rob Furness]

I think I have one of these, it's between my belly button and chest and is small (about the size of a 5p) and asymptomatic aside from feeling a little odd if I press hard on it.

Anyone know anything about them? I'm a bit scared of going to the GP really because the state of my Crohn's means that any operation that I have in my gut area could result in them removing a large amount of my gut (which would seriously mess me up) so I'm paranoid about them recommending surgery.

Anyone medical know whether it's likely I can just ignore it?

[Mike T]

Does it come and go or is it present all the time? Is it painful? If it does come and go, what makes it reappear? Coughing/sneezing/straining/lifting?
Not all hernias need surgery, and epigastric hernias need surgery much less often than, for example, inguinal (groin) hernias.They usually contain fat rather than bowel.

[Rob Furness]

It's there all the time and is only small, hasn't got any larger since I noticed it several months ago (although it may well have been there a lot longer). It doesn't hurt or have any other symptoms besides being a small lump and feeling a little peculiar if I try and press on it too much. When I lay down I can't even find it, it's only visible when I tense up. I think it probably is fatty tissue. Does that mean it doesn't really need attention?

[Mike T]

Assuming this is a hernia, I suspect it is "out" (incarcerated) all the time, but as it is so small, it needs tense muscles behind it for it to be apparent. The other two ways that hernias can complicate are obstruction, if they contain bowel and the bowel becomes blocked, and strangulation, if the contents of the hernia are not getting an adequate blood supply. Small painless incarcerated but non obstructed/non strangulated epigastric hernias can be left alone. Do let your GP see it to make sure it is a hernia, though it is difficult to imagine what else it could be.

[Rob Furness]

Cheers Mike, that's very helpful.

[Flopsy]

Rob I have had 2 of these in the past and I suspect that I have another - sadly for me they think there is a weakness in my connective tissue that may have to result in more invasive surgery at some point - although I am stupidly ignoring mine at the moment.

Epigastric hernias are ususally painless, with a small lump of fatty tissue protruding through a hole in the connective tissue of the abdominal muscles - although sometimes it can be parts of bowel etc. The location will usually be mid line somewhere above the belly button and below the rib cage. You will usually only feel them standing up and they often will not appear on scans. In short they are difficult little buggers to detect, pain is the usually indicator.

Mine only become really painful when I do long distance running or if I strain my stomach muscles a lot, then they have become strangulated which is exrutiatingly painful. Hernias will not repair themsleves and the advice is generally that they should be repaired as they can become more serious. I've had both mine repaired.

The surgery should not affect your bowels and would be a small incision in the upper abdomen to repair the hole. You can't mesh epigastric hernias usually becuase they are too small. 6 -8 weeks recovery.

By the way I am quite rare in having multiple hernias and so don't worry that you will get more.

Having had two and with the prospect of more surgery I know quite a bit about them so feel to ask away with any questions.

[Rob Furness]

Little update on this. I've been to my GP who said he wouldn't be able to tell if it contained bowel or just fatty tissue without doing an ultrasound, but he's happy to leave it providing I'm not getting symptoms. He did ask if it ever disappeared or could be pushed back in, which prompted me to try and have a poke about and see if it could. Result is it's now tender (idiot) I think I just messed with it too much though as it's not really painful, just slightly tender to touch. When manipulating it it felt a little like the same sensation as squeezing something through your teeth (only way i could think to describe it) but I still have no idea whether it is fat or bowel. I didn't take him up on the scan yet because I want to discuss it with my crohn's specialist first, but I probably will get it looked at if they ok it.

[Flopsy]

Little update on this. I've been to my GP who said he wouldn't be able to tell if it contained bowel or just fatty tissue without doing an ultrasound, but he's happy to leave it providing I'm not getting symptoms. He did ask if it ever disappeared or could be pushed back in, which prompted me to try and have a poke about and see if it could. Result is it's now tender (idiot) I think I just messed with it too much though as it's not really painful, just slightly tender to touch. When manipulating it it felt a little like the same sensation as squeezing something through your teeth (only way i could think to describe it) but I still have no idea whether it is fat or bowel. I didn't take him up on the scan yet because I want to discuss it with my crohn's specialist first, but I probably will get it looked at if they ok it.

The hernia won't necessarily show up on a scan at all, depends how small it is (epigastric are usually very small). Neither of mine have shown up on scans. The first one was operated on because they could feel it even though the scan didn't show it and the second one because I insisted I had another one and they needed to try and repair my scar anyway. That hadn't shown up on scan either. In fact the surgeon didn't believe me until he opened me up and saw it for himself. Doctors should trust that patients know their bodies better than they do!!

Good luck with it all.

[Zaf]

I had one of these a few years ago, quite small and found it while showering feeling a tender lump about 2 inches above my belly button. My Dr sent me to hospital and I had it fixed to ensure that it did not become strangulated as at that time I has a physical job that involved a lot of lifting and that was a risk factor. Healed very quickly and 20 years later I have had no lasting effects other than my scar is a tad bigger than the nice cosmetic jobs they do today . Can't advise on your crohn's but my understanding is that its an external repair to pop it (muscle) back in and stitch up to prevent it coming back out so should not be that invasive
Hope this helps, good luck
Zaf

[Rob Furness]

Crohn's consultant says to leave well enough alone unless I start getting symptoms. Any risk of perforating the bowel needs weighing extremely carefully for me as it could spell some life changing surgery which is obviously not what I want. I'm just trying to ignore it now and if I ever have to have an op or circumstances change I'll consider it then.