Epigastric Swelling (Differential Diagnosis Umbilical Hernia)

In this 1-year-old girl a painful swelling was found in the midline above the navel. The operative findings show a large piece of fat emerging from the peritoneal cavity. The diagnosis is a large epigastric hernia. The borders of the opened hernia sac are stretched by two forceps; the content consists of a part of the major omentum which leaves the abdominal cavity by a hole in the midline, has a configuration like a sandglass and causes pain because of traction on the peritoneum. Smaller epigastric hernias are more frequent. The piece of preperitoneal fat may be seen as a small midline nodule and may be palpated mainly on sitting up. Epigastric and paraumbilical hernias are not spontaneously reversible in contrast to many cases of umbilical hernia, and should therefore be operated.