anterior abdominal wall pathology

rectus sheath

forms a covering for the paired rectus abdominis muscles

rectus abdominis muscles

found on both sides of the midline of the anterior abdomen

the rectus abdominis muscles are divided by a band of connective tissue called the:

linea alba, which is located in the midline of the abdomen

rectus sheath hematoma

• caused by a rupture in the muscle or associated vasculature

• can be the result of abdominal trauma or may occur spontaneously

clinical findings of a rectus sheath hematoma:

• abdominal pain

• palpable abdominal mass

• discoloration of the skin in the area of the hematoma

• decreased hematocrit

sonographic findings of a rectus sheath hematoma:

blood can appear hypoechoic, hyperechoic, complex, and/or anechoic depending on the stage of development

endometriosis

ectopic, functional endometrial tissue

what is the most common site for endometriosis outside the female pelvis region?

the anterior abdominal wall

scar endometriosis

ectopic endometrial tissue located within the scar of a previous cesarean section

clinical findings of endometriosis of the abdominal wall:

• history of endometriosis

• prior cesarean section

• pain at the area of the cesarean section scar → possible pain that correlates with the menstrual cycle

• palpable mass

sonographic findings of endometriosis of the abdominal wall:

• well-defined, lobulated, or infiltrative mass

• hypoechoic to the adjacent tissue

how are abdominal wall hernias imaged?

• high-frequency transducer and standoff pad

• Valsalva technique used to show movement and change in size of the hernia

complications of abdominal wall hernias include:

incarceration, strangulation, and ischemia of the affected bowel

femoral hernia

• hernia that allows abdominal contents to protrude through the femoral canal

• location: medial to the femoral vein and inferior to the inguinal ligament

inguinal hernia

• can be further described as direct groin hernia or indirect groin hernia

• bowel protrudes into the groin

• makes up 75% of all hernias

• location: groin, scrotum, or labia

incisional hernia

• type of ventral hernia where bowel protrudes into a surgical incision site

• parastomal hernia is a type of incisional hernia adjacent to a stoma

• location: surgical incision site

linea alba hernia

• bowel protrudes through the fascia of the linear alba

• may be referred to as an epigastric hernia

• location: midline of the abdomen between the sternum and umbilicus

spigelian hernia

• bowel protrudes into a weakened area in the lower one-fourth of the rectus muscle through the spigelian fascia

• location: midline of the abdomen between the umbilicus and symphysis pubis

umbilical hernia

• type of ventral hernia where bowel protrudes into the umbilicus

• most common type of ventral hernia and may be referred to as paraumbilical hernias in adults