Symptoms of epigastric hernias in Sub-Saharan Africa typically include a small, painless bulge in the upper abdomen that becomes more noticeable during activities that increase abdominal pressure. Some hernias may cause discomfort or occasional pain, especially with strenuous activity. Rarely, larger hernias can lead to bowel-related symptoms like constipation if abdominal contents become trapped. In cases of complications such as incarceration, the bulge may become tender or painful, accompanied by redness or inflammation of the overlying skin. Early recognition and medical evaluation are crucial to manage epigastric hernias effectively and prevent complications in this region.

In low resource settings such as Sub-Saharan Africa, clinical findings of epigastric hernias typically include a palpable, usually painless bulge in the upper abdomen that may vary in size and firmness. These hernias are often asymptomatic but can cause discomfort or occasional pain, especially during physical activity. They rarely present with signs of bowel obstruction. Early detection through physical examination is crucial, as advanced imaging may not be readily available. Prompt referral for surgical evaluation is necessary to manage symptomatic hernias and prevent complications like incarceration or strangulation.

Accurate diagnosis is essential, often relying on careful clinical evaluation and, when available, imaging studies such as ultrasound to differentiate these conditions from epigastric hernias.

1. Lipoma: A benign tumour composed of fat cells that can present as a soft, painless lump in the upper abdomen.
2. Diastasis Recti: Separation of the abdominal muscles, often occurring after pregnancy or due to obesity, resulting in a visible bulge in the midline.
3. Subcutaneous Abscess: An infected pocket of pus beneath the skin, which can cause a tender, swollen area in the upper abdomen.
4. Incisional Hernia: A hernia that develops at the site of a previous surgical incision, which can appear like epigastric hernias but typically occurs lower on the abdomen.
5. Inguinal Hernia: Although more common in the groin, inguinal hernias can sometimes present with referred pain or bulging in the upper abdomen, leading to confusion with epigastric hernias.

Investigations for epigastric hernias in Sub-Saharan Africa primarily involve clinical examination to assess the hernia's characteristics, such as size and location. Ultrasound is the main imaging tool used to confirm the diagnosis, evaluate the hernia sac, and detect complications like incarceration. In some cases, CT scans may be utilized for more detailed imaging if necessary. Clinical judgment guides the need for additional investigations, such as laboratory tests, to assess for complications like infection. These diagnostic approaches are tailored to the healthcare resources available in the region, aiming to ensure timely and effective management of epigastric hernias.

Treatment of symptomatic epigastric hernias in Sub-Saharan Africa typically involves surgical intervention, which is the primary approach to prevent complications. Key aspects of treatment include:

Surgical Repair: Surgery is performed to close the defect in the abdominal wall through techniques such as primary suture repair or mesh reinforcement, depending on the size and complexity of the hernia.  This can often be done under local anaesthesia as a day procedure, making it feasible in settings with limited resources for prolonged hospital stays.

Post-operative care: Patients receive instructions on wound care, activity restrictions, and signs of complications. Monitoring for immediate post-operative issues like pain, infection, or recurrence is crucial.

Community Involvement: Community health workers play a vital role in patient education, ensuring adherence to post-operative instructions, and facilitating follow-up care, especially in rural or underserved areas.

Capacity Development: Enhancing healthcare infrastructure and training healthcare providers in surgical techniques are essential to improve access to and quality of surgical care for epigastric hernias in Sub-Saharan Africa

Prevention of epigastric hernias in Sub-Saharan Africa involves promoting healthy lifestyle practices such as maintaining a healthy weight, using proper lifting techniques, and avoiding smoking. These measures help reduce intra-abdominal pressure and strain on the abdominal muscles. Educating communities about the importance of early medical attention for conditions like chronic coughing and promoting good bowel habits also plays a crucial role. By addressing these factors through health education and lifestyle modifications, the incidence of epigastric hernias can be minimized, enhancing overall health outcomes in the region.