A linea alba hernia protrudes anywhere between the xiphoid process and the umbilicus, but usually in the midline between these two structures. About 3-5% of people develop epigastric hernias. They are common between the ages of 20 and 50, and occur more often in men than in women. About 20% of the hernias are multiple and 80% occur just off the midline.
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 portion of greater omentum because the mouth of the hernia is usually small.
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