Abdominal wall
General considerations
Surgical anatomy
Physiology
Abdominal anatomy and surgical incisions
Congenital abnormalities
Acquired abnormalities
- Rectus abdominis diastasis
- Bulge between the rectus muscles d/t linea alba weakening.
- Since it’s not associated with fascia defect, not palpable while supine.
- Rectus sheath hematoma
- Associated with acute trauma or pain.
- Typically occurs d/t rupture of the inferior epigastric artery.
- Size does not change with Valsalva.
- Tenderness may worsen with abdominal contraction (Carnett sign)
- Bluish discoloration (3,4? ?)
- ??, ???, ?? ??? angio-embolization
- Desmoid tumor
- Subcutaneous lipomas are not typically located in the midline and do not enlarge with Valsalva.
- Other abdominal wall tumors
- Abdominal wall hernias
- Palpable bulge that enlarges with increased intraabdominal pressure (eg, coughing)
- Incisional hernias
- Obesity, prior vertical or midline incision ? gradual fascial breakdown for months to years.
- Mass size increases with Valsalva, palpable while supine.
- Postoperative wound dehiscence
- Superficial: separations of the skin and subcutaneous tissue with intact rectus fascia
- Deep (fascial): dehiscence involve the rectus fascia (ie. nonintact) and result in exposure of the intraabdominal organs to the external environment.
- Management
- Abdominal binders – contraindicated in the patients with bowel evisceration b/c they can cause strangulation and perforation.
- Emergency surgery
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