Presentation
Left flank pain post-cesarean section in 2021; bulge around left iliac fossa region.
Patient Data
There is divarication of the rectus abdominis muscle associated with a large defect of the linea alba in the infra-umbilical region. The diastasis of the recti reaches 8 cm (normal: 2.7 cm) with a craniocaudal extent of the divarication of approximately 10cm. The defect in the linea alba is approximately 8 cm, resulting in a very large hernia at the same site.
The lower end of the defect is 5 cm above the pubis; the upper end is 3 cm below the umbilicus. The hernia sac is 6 x 21 x 13 cm (AP x TRV x CC). The bulk of the sac is left-sided, though the defect is in the midline. The sac contains a loop of the transverse colon and multiple loops of the small bowel, with the herniated loops demonstrating the normal flow of oral contrast.
Case Discussion
During pregnancy, the linea alba softens under the influence of hormones (relaxin and estrogen) and mechanical stretching resulting from the adjustment of the growing fetus 1. For this reason, the width of the linea alba gradually increases throughout the trimester, with the greatest frequency in the third trimester.
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