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Paediatric epigastric hernia

OVERVIEW

An epigastric hernia is a kind of hernia that develops in the upper region of the abdomen, between the breastbone and the navel. It is a common condition in children and is often present from birth or develops during the first few months of life. Epigastric hernias are caused by a weakness in the abdominal wall, which allows fatty tissue or sometimes small intestines to bulge through the muscles. While epigastric hernias in children are generally not serious and may resolve on their own, they can sometimes require surgical treatment if they become larger or cause discomfort.

Signs and symptoms of epigastric hernia in children

Epigastric hernias in children may not always produce noticeable symptoms. In some cases, they may only be detected during a routine physical examination.

A visible bulge or protrusion in the upper abdomen, especially when the child is crying, coughing, or straining.
Pain or discomfort around the site of the hernia may exacerbate with physical activity or when the child is in a supine position.
Nausea, vomiting, or poor appetite may occur if the hernia is large enough to put pressure on the digestive tract.
In rare cases, the hernia may become trapped or "incarcerated," which can cause severe pain, swelling, and redness in the affected area. If this happens, it is considered a medical emergency and requires immediate attention.

It's crucial to mention that some epigastric hernias may be asymptomatic and may only be detected during a routine physical examination.

Treatment

In many cases, small epigastric hernias in children may not require any treatment and may resolve on their own as the child grows. However, if the hernia is large, causes discomfort or other symptoms, or shows no signs of improvement, surgical treatment may be necessary.

The surgical procedure to repair an epigastric hernia in children is typically performed under general anaesthesia and involves making a small incision near the hernia site. The hernia sac is then pushed back into the abdomen, and the weakened area of the abdominal wall is reinforced with sutures or a mesh patch to prevent the hernia from recurring.

After surgery, the child may experience some discomfort, but this can typically be managed with pain medication. The child may need to avoid strenuous activities for a period of time to allow the surgical site to heal properly. Compliance with the physician's directives regarding post-operative care and regular follow-up appointments to track the healing process is crucial.

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Dr Mangray, the founder of KZN Specialised Paediatric Surgical Service, and his associates, Dr Ngobese, Dr Govender and Dr Dube-Zvirikuzhe, have a well-established reputation for caring for children right until late adolescence.

FREQUENTLY ASKED QUESTIONS

FAQ

1How are epigastric hernias diagnosed in children?

Epigastric hernias are typically diagnosed through a physical exam, during which the doctor may feel for a bulge in the upper abdomen. In some cases, imaging tests such as ultrasound may be used to confirm the diagnosis.

2What causes epigastric hernias in children?

Epigastric hernias are caused by a weakness or gap in the abdominal muscles in the upper part of the abdomen. This weakness can be present at birth or can develop over time.

3Can epigastric hernias in children recur after surgery?

While recurrence is rare, it is possible for an epigastric hernia to recur after surgical treatment. The use of mesh to reinforce the weakened area of the abdominal wall during surgery can help reduce the risk of recurrence.