Posterior Rectus Sheath Hernia Causing Intermittent Small Bowel Obstruction

Abstract

A posterior rectus sheath hernia is an abdominal wall hernia that is rarely encountered. Owing to its rarity, it can be easily overlooked in the setting of a patient presenting with abdominal pain. We report a case of a posterior rectus sheath hernia that caused intermittent small bowel obstruction. The unusual aspects of this case are that the defect was large, measuring 6 cm in the transverse diameter, and that it contained small bowel within a large portion of the rectus sheath. Because the defect was large and affected nearly the entire posterior rectus sheath, it was difficult to discern on computed tomography until a small bowel obstruction developed. In this case, a limited awareness of this clinical entity contributed to the delay in diagnosis.

Laparoscopic approach for a spontaneous posterior rectus sheath hernia

“…Spontaneous posterior rectus sheath hernias were first documented in 1937 and there are only 10 cases published in the literature [2, 3, 5]. They belong to the group of interparietal hernias in which the hernia sac lies between the layers of the abdominal wall [4].…”

Spontaneous posterior rectus sheath hernia: a case report

“…Spontaneous posterior rectus sheath hernias were first documented in 1937. They are exceedingly rare with a case series in 2009 identifying only eight cases in the literature with two additional cases reported in 2014 and 2017 [ 4 – 6 ]. Among three different types of intraparietal hernias, interstitial is the most common [ 2 , 3 ].…”

“…A majority of posterior rectus sheath hernia cases are post-surgical [ 5 , 10 ] or post-traumatic. The remainder occur in persons without surgery [ 11 ] and are often reported as having a congenital origin [ 4 ]. In the literature, the age at diagnosis widely ranged from 25 to 83 years and posterior rectus sheath hernias were more common in women than in men [ 1 , 6 , 12 ].…”

“…In the literature, the age at diagnosis widely ranged from 25 to 83 years and posterior rectus sheath hernias were more common in women than in men [ 1 , 6 , 12 ]. Most hernias in the literature were reported as being approximately 2 cm in size, with the largest being 6 cm [ 4 ]. Clinical presentation can vary from abdominal pain, nausea, and vomiting to being relatively asymptomatic [ 2 , 3 , 5 , 6 ].…”

“…Our case was managed conservatively due to no evidence of obstruction, ischemia, or strangulation, which would have warranted urgent surgery [ 3 ]. In the literature, there were cases in which patients were discharged after conservative management and only years later they had exploratory laparotomy for hernia repair [ 4 ].…”