Most surgeons today are well acquainted with the usual variety of palpable epigastric hernia. Very few, however, have had any experience with small defects in the linea alba or the rectus sheath in which no mass can be felt preoperatively. The present paper attempts to point out the distinguishing features of this syndrome and to clarify the management as seen in four cases.
Epigastric hernias presenting a small palpable mass in the upper abdomen have been well understood since Richter6 described so clearly his experience in 1785. A perusal of the textbooks and journals written around the turn of the present century reveal very clear descriptions of epigastric hernias and their management.2,4 If one picks up modern textbooks written since World War II, there is very little on the subject, and practically nothing has been written in the past decade pertaining to this interesting problem. Alexis V. Moschcowitz