Hernia which often simulates a peptic ulcer is: March 2005

Ans. D: Fatty hernia of linea alba A linea alba hernia protrudes anywhere between the xiphoid process and the umbilicus, but usually in the midline between these two structures. The epigastric hernia commences as a protrusion of extra-peritoneal fat where the linea alba is pierced by a small blood vessel. The swelling enlarges and drags a pouch of peritoneum with it. Frequently, the sac is empty or contains a small poion of greater omentum because the mouth of the hernia is usually small. The patient with an epigastric hernia may be asymptomatic. The features in a symptomatic patient may include: Pain - which varies from mild epigastric pain to a deep burning pain radiating to the back or the lower abdomen An abdominal mass - which may be palpable and tender Abdominal bloating Vomiting, nausea Aggravated by eating Relieved by reclining so that the mass falls away from the anterior abdominal wall Smaller hernia are prone to incarceration and strangulation.They frequently contain only extraperitoneal fat. Large ones seldom strangulate and additionally contain omentum.