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Had epigastric hernia repair. Found hard lump at the site of repair. Serious?

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General Surgeon
Practicing since : 2008
Answered : 5762 Questions
I had a small epigastric hernia repair done on April 29, It was uneventful and the incision seems clean without inflammation. I had a little pain for about 36 hours, a couple of Extra Strength Tylenol was plenty for that, and I have monitored it carefully since then without drugs so I knew what movements caused discomfort and would then stop whatever I was doing, by far the worst such discomfort was in the first week when transferring between lying down and sitting. All seems well except that there is a hard lump right under the incision, about the same size as the hernia was (approximately 1.5 cm diameter) and it hurts a bit when I've been standing or not leaning back for a while. Is this likely to be swelling and/or scar tissue forming, or is it likely that I reherniated despite all the care I have taken? My surgeon is away so the follow-up appointment is not until May 21 and this is making me anxious.
Posted Thu, 6 Jun 2013 in Digestion and Bowels
Answered by Dr. Grzegorz Stanko 17 minutes later

Thank you for the query.

It sounds like hernia has recurred. Especially if the mesh were not inserted during the surgery. Painful lump which is more visible when standing and coughing is quite characteristic for hernia. The pain can also be more intense when lifting heavy objects.

In epigastric area, hernia usually contains fatty tissues and most likely this is what creates the lump. However if any abdominal pain, nausea, vomiting, lack of stool and gas will appear, ER should be visited.

Wound infection would rather give redness, pain and discharge from this area. However sometimes stitches irritate tissues, and can cause lump-like area. But yours seems to be too big for an infection of stitches.

I suggest you to visit your surgeon (it should be sooner if the lump is painful). In case of any doubts, soft tissues ultrasound should be done.

If this is hernia, next surgery should be done with mesh. There is a great laparoscopic method where the mesh is applied from the inside. You should ask your surgeon about it.

Hope this will help. Feel free to ask further questions.
Above answer was peer-reviewed by
Follow-up: Had epigastric hernia repair. Found hard lump at the site of repair. Serious? 29 hours later
I called my surgeon, he thinks it is more likely to be a seroma. It is right under the skin and does not recede when I lie flat on my back which the hernia used to do. I am resting more to see if it shrinks in width over time until my appointment on May 21. It is also harder than the herniated tissue and that is consistent with fluid rather than fat. I understand it may be reabsorbed over weeks, or maybe be drained by the doctor.
Answered by Dr. Grzegorz Stanko 8 minutes later

Seroma is a fluid collection due to peritoneum (the membrane which covers abdominal cavity) left in the wound. Seroma does not give hard lump. It gives even, soft area with fluid under the skin.

An abscess is more like to give a hard lump with fluid inside.

Like I have mentioned before, in case of hernia which is stuck, this lump wont be able to recede. So this does not rule hernia out.

If it is a seroma, it can be drained indeed. However you need to know that it can take even few months for the fluid to stop collecting under the skin.

But if nothing is changing and you are fine, I think you can wait till 21 of May. Only physical examination (and ultrasound) can give exact diagnose.

Hope this will help.
Above answer was peer-reviewed by
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