Diagnosis: Ventral hernia
An abdominal ultrasound revealed subcutaneous, peristalsing bowel loops consistent with a ventral hernia (FIGURE 2). A small amount of ascites was also found.
Most abdominal wall hernias occur in the inguinal region, but in 2003 there were 360,000 ventral hernia repairs performed in the United States.1 Ventral hernias can be further classified as primary or incisional (depending on patient history) and according to their location—midline (epigastric and umbilical) or lateral (Spighelian and lumbar).2
An abdominal hernia typically presents as a nontender, protruding mass that is either stable in size or gradually expands. The mass may be pulsatile, depending on the contents of the hernia and their activity. Hernias may be reducible, meaning that the contents are able to return to the abdominal cavity with external pressure or if the patient is supine. If a hernia is not reducible, then incarceration becomes a significant risk. Compromised blood supply to the incarcerated organ(s) can lead to tissue necrosis and viscous perforation. Epigastric hernias, in particular, carry a high risk of incarceration.3
FIGURE 2
Another view of the ventral hernia
3 conditions comprise the differential
The differential diagnosis includes diastasis recti, ascites, and lipoma.
Diastasis recti is a separation of the rectus abdominus muscles at the linea alba. It is seen almost exclusively in pregnant women and newborns. In this condition, the flat abdominal wall muscles remain intact, and thus abdominal contents would not protrude.
Ascites is the collection of fluid in the abdominal cavity, secondary to conditions such as cirrhosis or congestive heart failure. In ascites, the abdomen is dull to percussion, with no discrete, irregular mass.
Lipoma is a solid benign tumor composed of fatty tissue. A lipoma of this size is rare, and would be solid to percussion. Also, it would not be reducible with the patient supine.