EPIGASTRIC HERNIA

EPIGASTRIC HERNIA

AETIOPATHOGENESIS

आयुर्वेदिक दृष्टिकोण (AYURVEDIC VIEW):

• Epigastric hernia can be correlated with Antra Vriddhi or Viddha Antra conditions mentioned under अग्निकोष्ठ गत व्याधि (diseases of abdominal cavity).

• Weakening of मांसधातु (muscle tissue) and स्नायु (ligaments), especially in उदरप्रदेश, results in protrusion.

• Tridoshic imbalance, especially Vata dosha aggravation, is a key factor.

सुश्रुत संहिता नि.स्थान 1/11
"मांसपेश्यः सन्धयः स्नायवः कुपिता वायुनाऽनिलात्।
अनुविद्धा विवरं कुर्वन्ति तत्र पतनं गतिः॥"
– Explains the pathological opening caused by vitiated Vata leading to protrusion.

MODERN MEDICAL VIEW:

• Occurs due to weakness or defect in the linea alba, above the umbilicus and below the sternum.

• Most common in middle-aged males.

• Predisposing factors:

  • Congenital defect in the abdominal wall

  • Chronic cough, constipation, obesity

  • Postoperative weakness

  • Sudden increase in intra-abdominal pressure

CLASSIFICATION

BASED ON SIZE:

• Small: < 1 cm

• Medium: 1–3 cm

• Large: > 3 cm

BASED ON CONTENT:

• Preperitoneal fat (most common)

• Omentum

• Small intestine (rare)

AYURVEDIC CORRELATES:

• Antravriddhi – Herniation of intestines

• Viddha udara roga – Perforation or tearing conditions

CLINICAL FEATURES

• Small midline swelling between xiphoid process and umbilicus

• More visible on standing or coughing

• May reduce on lying down (reducible hernia)

• Pain or burning sensation, especially after meals or exertion

• Nausea, bloating, constipation in complicated cases

आयुर्वेदिक लक्षणानुसार (as per Antravriddhi/Anilodara):

• उदरवृद्धि

• वेदना स्थानिक वा चल

• मलविघात

• कफवातज विकृति

EXAMINATIONS

INSPECTION:

• Visible swelling in the upper abdomen

• Increases on coughing or straining

• Skin over swelling may show stretching

PALPATION:

• Soft, reducible mass

• Expansile impulse on coughing

• Tenderness may be present

SPECIAL TESTS:

• Cough Impulse Test

• Reducibility Test

• Valsalva Maneuver

INVESTIGATIONS & DIAGNOSIS

ULTRASONOGRAPHY (USG):

• Confirms defect in the linea alba

• Identifies contents (fat, omentum, bowel)

CT SCAN (ABDOMEN):

• Gives detailed anatomy and content

• Preferred for large or recurrent hernias

DIAGNOSIS IS CLINICAL, supported by imaging studies.

COMPLICATIONS

• Incarceration

• Strangulation

• Obstruction of bowel

• Infection or inflammation of herniated contents

• Recurrent hernia post-repair

सुश्रुत संहिता चि.स्थान 9/18
"यदा तु दोषा विकृतास्तत्र सन्निपातजं भवति
सामान्यलिङ्गानि च तस्य गात्रदाहारुच्यरोचकाः॥"
– Suggests systemic signs in case of complications.

MANAGEMENT

AYURVEDIC MANAGEMENT:

• Initial Treatment:

  • Langhana, Deepana, Pachana in case of Ama

  • Vatahara Chikitsa – Use of oils like Bala Taila, Ashwagandhadi Taila

  • Abhyanga, Swedana – for local strengthening

  • Internal use of Guggulu, Ashwagandha, Kapikacchu

Classical Sloka – Charaka Samhita Chikitsa 15/72:
"बृंहणानि बलानि च स्नेहान् वापि प्रयोजयेत्।
स्नाय्वस्थिमांसवृद्ध्यर्थं…"
– Emphasizes rejuvenation and tissue strengthening in structural disorders.

SHASTRIYA CHIKITSA (SURGICAL TREATMENT):

• Chedana & Bandhana described in Kshudra Rogas Chikitsa for protrusions

• Ksharasutra or Agnikarma if localized and reducible

• Avoid over-exertion and encourage gradual abdominal strengthening

MODERN SURGICAL MANAGEMENT:

• Herniorrhaphy: Defect repair using sutures

• Hernioplasty: Mesh repair (tension-free) is standard

• Laparoscopic Repair: Minimally invasive, faster recovery

• Preoperative care includes bowel regulation, weight control

POSTOPERATIVE ADVICE:

• Avoid lifting heavy weights

• Use abdominal binder

• Address constipation and cough

PREVENTION

• Maintain ideal weight

• Treat chronic cough, constipation early

• Strengthen core abdominal muscles

• Avoid sudden strain on abdominal muscles

PROGNOSIS

• Good with early diagnosis and proper surgical correction

• Recurrence possible if mesh is not used or risk factors persist

• Ayurvedic Rasayana and supportive therapies can be used post-surgery for tissue rejuvenation