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Epigastric hernia, a form of abdominal ventral hernia, accounts for 0.5 – 10.0% of all abdominal wall hernias. These may be congenital due to incomplete midline fusion of developing lateral abdominal wall domains or acquired. It usually occurs in individuals in the age groups of 20 to 50 years and in infants. It is rarely large enough to admit more than a small amount of extra-peritoneal fat. We discuss an epigastric hernia known only for little more than 4-hours, presented strangulated, leading to ischaemia of small bowel requiring resection and review literature on epigastric hernias and their complications.