Arcuate Line Hernia With Umbilical Hernia: Radiological Findings and Laparoscopic Intraperitoneal Onlay Mesh Repair

Arcuate line hernia (ALH) is a rare internal hernia in which abdominal contents protrude into the retrorectus space through a defect between the arcuate line and rectus abdominis. Because the bulge lies behind the rectus abdominis muscles, symptoms are often non-specific, making diagnosis difficult. A 73-year-old woman presented with intermittent left lower abdominal pain. Thin-slice prone computed tomography obtained during the Valsalva maneuver demonstrated small bowel herniation through the left arcuate line, consistent with ALH, along with a concomitant umbilical hernia. Laparoscopic intraperitoneal onlay mesh (IPOM) repair was performed using a composite mesh covering both defects with adequate overlap, secured with transfascial sutures and absorbable tacks. The postoperative course was uneventful; the patient was discharged on postoperative Day 3 and remained symptom-free without recurrence at 1 year. To our knowledge, this is the first reported case of ALH with a concurrent umbilical hernia repaired laparoscopically using the IPOM technique.