Hernia of the posterior lamina of the rectus abdominis muscle sheath: report of a case.

A case of hernia of the posterior lamina of the rectus abdominis muscle sheath in a 30 years old female, six months pregnant, is reported. The symptomatology was almost exclusively characterized by a persistent abdominal pain, located in the right costal margin at the intersection with the right adsternal line and aggravated by changes in position and by increases of intra-abdominal pressure. No bulge or specific hernial defect was clinically appreciable. The key to diagnosis, in this case, was an echography of soft tissues performed in the area where the pain was greater: with the patient in orthostatic position, it was possible to demonstrate a defect in the posterior sheath of the rectus abdominis muscle, that, increasing the intra-abdominal pressure, let pass preperitoneal fat between sheath and muscle. Both the predisposing (anatomic and clinical) factors and the provocateurs ones, probably involved in the genesis of this peculiar case, are discussed.