A hernia is a weak area in the abdominal wall that provides a site for the protrusion of an abdominal organ. An epigastric hernia is described as a fatty hernia of the intestine protruding through an opening in the midline and above the umbilicus. An umbilical hernia is a protrusion of peritoneum and fluid, omentum, or a portion of abdominal organs through fibrous muscle tissue around the navel.

Hernias result from weakened abdominal muscles. These weaknesses occur as a result of injury, congenital malformation, aging, or conditions that increase intra-abdominal pressure. Some of these conditions might include heavy lifting, straining, pregnancy, or obesity.

An umbilical hernia presents as a soft protrusion over the umbilicus. When the bulge persists, and nausea and vomiting are present, the hernia may become incarcerated or strangulated. In adults, umbilical hernias cause problems when some of the abdominal contents become trapped, especially fat or intestine. Impairment of the blood supply to the trapped tissue can lead to tissue damage. When the hernia traps fat or intestine, as is the case with epigastric hernias, it may cause pain or abdominal cramps.

Diagnosis of hernia is based on performing a physical examination and obtaining a detailed history. If a bowel obstruction is suspected, an abdominal x-ray and a white blood cell (WBC) count may be done prior to surgery.

Treatment is based on the classification of the hernia. A hernia classified as reducible can be placed back into the abdominal cavity by manual manipulation. Irreducible or incarcerated hernias cannot be reinserted into the abdomen, and can cause intestinal obstruction that may result in strangulation. Surgery is the usual and preferred treatment for hernias. A strangulated hernia requires emergency surgery to prevent the development of gangrenous bowel. A corset or truss to keep the abdominal contents from protruding may be helpful while waiting for surgery, or for some elderly persons who cannot tolerate surgery. The surgical repair of a hernia is known as herniorrhaphy. Reinforcement of a weakened area is termed hernioplasty.

If herniorrhaphy is performed without complications, normal activities may usually be resumed 4 to 6 weeks after surgery. If immediate care is not given for strangulation, necrosis or gangrene may develop. These conditions may require bowel resection of the involved area or a temporary colostomy.

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