CONGENITAL EPIGASTRIC DEFECTS

Congenital epigastric defects occur anywhere in the linea alba from the navel to the xiphoid process. They represent almost 5% of all hernias defect that presents in children. Most epigastric hernias occur in the midline, are small (15-25 mm), asymptomatic and reducible. Multiple fascial defects can also be present in 20% of all cases. The defect might arise congenitally from an abnormally wide orifice of a blood vessel during development of the linea alba. The bump is the result of a piece of preperitoneal fat stuck through the fascial defect. Tenderness is an unusual symptom while growth of the defect occurs with time. Most surgeons recommend repair of the defect at the time of presentation. Repair is an outpatient procedure done under general anesthesia with low morbidity and risk of recurrence. Voluminous epigastric hernia (5-10 cm) with a sac that contains epiploic appendages or viscera (ileum loops, stomach) has also been rarely reported in infants.