982 Abdominal Wall Reconstruction Following Full Thickness Bilateral Rupture of the Rectus Abdominis
D Suhail, O Smith, P Lim, S Chintapatla- Surgery
Abstract
Introduction
Rupture of the rectus abdominis is a rarely seen condition and there is no consensus its management.
Case Description
A 20-year-old male presented with severe lower abdominal pain that occurred during exercise (i.e., ‘burpees’). MRI revealed full-thickness bilateral rupture of the rectus abdominis. Abdominal wall reconstruction involved bilateral rectus muscle repair using plastic surgical techniques and placement of a biosynthetic mesh (Phasix ST from BD) in the retrorectus plane. Postoperatively, our patient could walk pain-free at 3 weeks, jog pain-free at 10 weeks, and run up to 2 miles at 25 weeks.
Literature Review
There is no consensus on how to manage this rare injury or whether surgical or conservative treatment yields better results. Pubmed, Medline and Embase databases were searched to identify relevant studies using the following MeSH terms, “rectus abdominis” and “rupture”, as well as their free text counterparts. The search resulted in 391 articles. Manual cross-referencing was performed, limiting the included articles to 8 for review. 6 out of the 8 selected articles discussed management using conservative means, while only 2 cases were managed surgically. Interestingly, no other exercise-related cases in the literature were managed surgically. Instead, all exercise related cases were managed conservatively, while traumatic cases were managed surgically. Among both surgically and conservatively treated patients, all patients returned to normal levels of activity.
Conclusions
Full-thickness, bilateral rupture of the rectus abdominis can occur during exercise. Intervention depends on the size and severity of the injury, but surgical and conservative treatment yield similar results.