Disorders of the rectus abdominis muscle and sheath: a 22-year experience

To determine the spectrum of diseases that can involve the rectus abdominis muscle and sheath (RMS) and to describe the clinical features of these conditions.

A retrospective medical record review of RMS disorders seen at The New York Hospital-Cornell Medical Center from 1971 to 1992.

A total of 40 patients with diseases of the RMS were identified. Thirty patients had primary diseases of the RMS, most commonly desmoid tumor and hematoma. Secondary disorders of the RMS included abscesses from diverticulitis, a perforated sigmoid carcinoma, gallbladder empyema, and disseminated actinomycosis. Eleven of 18 patients with desmoid tumors had familial adenomatous polyposis (FAP). The desmoid tumors in patients with FAP resulted in greater morbidity and mortality than those in patients without FAP. All patients with hematomas were on anticoagulation or had a history of trauma, vigorous coughing, or physical exertion.

1) RMS disease should be suspected in patients with a palpable abdominal mass and a history of familial adenomatous polyposis, trauma, anticoagulation, or vigorous coughing or exercise. 2) The most common non-neoplastic condition of the RMS is a hematoma. 3) The desmoid tumor is the most common neoplasm of the RMS. 4) Abdominal ultrasonography and CT readily distinguish RMS disease from intraabdominal pathology.