Correct answer is: Epigastric hernia with coexisting rectus abdominis diastasis

Discussion

The ultrasound images revealed an epigastric hernia with coexisting rectus abdominis diastasis.

Image 1 and 2 show a small defect in the linea alba measuring 0.4 x 0.6 cm with herniation of preperitoneal fat. On image 3, the gap between the rectus abdominis muscles is seen measuring 2.7 cm. On ultrasound examination, sometimes only a small defect in linea alba is seen, without herniation of preperitoneal/omental fat, and rarely one finds herniation of bowel or stomach (1).

Epigastic hernias are defined as hernias occurring through a defect in the midline from above the umbilicus to the xiphoid process of the sternum. They represent 1.6 to 3.6 % of all abdominal wall hernias and are more common in men. Other risk factors include obesity, pregnancy, rectus diastasis, extensive physical training and connective tissue disorders. Epigastric hernias are often asymptomatic and the patient often presents to the clinic because of a small lump palpated in the upper abdomen. In most cases they are diagnosed by clinical examination alone, but imaging by ultrasound or CT can be considered when the diagnosis is uncertain. Asymptomatic patients can follow a watchful waiting strategy, but symptomatic patients often undergo surgery with repair of the midline defect with sutures or mesh (2-3).

Conflicts of Interest

The authors declare no conflict of interest

References

1. Epigastric hernia | Radiology Reference Article | Radiopaedia.org. Available online: https://radiopaedia.org/articles/epigastric-hernia (accessed on 22.12.2021)
2. A. Henriksen, A. Montgomery, R. Kaufmann, F. Berrevoet, B. East, J. Fischer, W. Hope, D. Klassen, R. Lorenz, Y. Renard , M. A. Garcia Urena and M. P. Simons on behalf of the European and Americas Hernia Societies (EHS and AHS). Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society. Br J Surg 2020 Feb;107(3):171-190.
3. Overview of abdominal wall hernias in adults – UpToDate. Available online:
   https://www.uptodate.com/contents/overview-of-abdominal-wall-hernias-in-adults?search=epigastric%20hernia&source=search_result&selectedTitle=1~19&usage_type=default&display_rank=1 (accessed on 26.12.2021).