Can a Patient Develop a Hernia Above the Umbilical Line, Halfway Between the Midline and the Mid Axillary Line?
Yes, a patient can absolutely develop a hernia in this location—this would be classified as a lateral abdominal wall hernia or Spigelian hernia, which occurs through defects in the abdominal wall musculature outside the traditional midline or paramedian locations.
Anatomical Basis for Lateral Hernias
The location you describe—above the umbilicus, halfway between the midline and mid-axillary line—corresponds to the lateral abdominal wall where the transversus abdominis, internal oblique, and external oblique muscles overlap. 1
Congenital lateral abdominal wall hernias can occur in this region, affecting all layers of the muscular wall, and have been documented above the anterior axillary line. 1
Incisional hernias are particularly common in this location following surgical incisions. The 2023 World Society of Emergency Surgery guidelines classify laparotomy incisions into midline, paramedian, transverse, and oblique approaches—all of which can result in hernias at various locations along the abdominal wall. 2
Incisional Hernia Risk in This Location
The lateral abdominal wall is a recognized site for incisional hernia development, particularly after non-midline surgical approaches:
Paramedian incisions (both conventional medial and lateral approaches where the rectus muscle is transected) can lead to hernias in the region you describe. 2
Transverse and oblique incisions (such as subcostal/Kocher incisions) frequently traverse this anatomical area and carry a 2-40% risk of incisional hernia formation. 2
The incidence of incisional hernias following major abdominal surgery ranges from 2-40%, with the location depending on the original surgical approach. 2
Clinical Presentation Considerations
These lateral hernias may be difficult to detect clinically, especially in obese patients:
Umbilical and lateral abdominal wall hernias can be "invisible" in obese patients without obvious bulging, requiring high clinical suspicion and imaging for diagnosis. 3
Routine palpation of potential hernia sites along the entire abdominal wall—not just the midline—is necessary in patients presenting with abdominal symptoms. 3
CT imaging with oral contrast is the preferred diagnostic tool when clinical examination is equivocal or in obese patients. 3
Risk Factors for Development
Multiple patient and surgical factors increase the risk of hernia formation in this location:
Patient factors include diabetes, chronic pulmonary disease, smoking, obesity, immunosuppression, surgical site infection, and previous abdominal surgery. 2
Emergency surgery settings carry higher risk compared to elective procedures. 2
Female gender, obesity, and ascites are additional risk factors for abdominal wall hernias. 4
Common Pitfall to Avoid
Do not assume that hernias only occur at the midline or umbilicus. Any previous surgical incision site—including lateral, transverse, or oblique approaches—can develop incisional hernias. 2 In patients with unexplained abdominal pain or bowel obstruction, systematically examine and consider imaging of all potential hernia sites, including lateral locations between the midline and mid-axillary line. 3