Abstract
Purpose
An arcuate line hernia (ALH) is a rare diagnosis with no consensus on how to deal with this condition either when symptomatic or when found accidentally. Suggestions for laparoscopic and open operative techniques are given together with a review of the literature and a presentation of three new cases.
Material
The PubMed database was searched for publications on ALH. Identified cases, including three from our department, are reported.
Results
Five males and two females, with a median age of 53 years were identified. Three patients were correctly diagnosed on a preoperative CT scan and the rest at surgery. Two patients had bilateral ALHs and four had other concomitant hernias repaired. Small bowel was present in the hernia in three cases and sigmoid colon in one. In one case, an emergency operation was performed due to bowel incarceration. Five patients had laparoscopic repairs, three with mesh and two without. Two patients, one converted from laparoscopic to open operation, had open mesh repairs. The postoperative course was uneventful in all cases, and no recurrences have been reported at a median follow-up of 6 months.
Conclusions
A laparoscopic approach is recommended for diagnostic purposes, for pre-peritoneal mesh placement and for repair of concomitant hernias in both elective and emergency settings. Highlighting its existence might help general surgeons in interpreting an unusual finding on a CT scan or at operation.
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References
Cappeliez O, Duez V, Alle JL, Leclercq F (2003) Bilateral arcuate-line hernia. Am J Roentgenol 180(3):864–865
Coulier B (2007) Multidetector computed tomography features of linea arcuata (arcuate-line of Douglas) and linea arcuata hernias. Surg Radiol Anat 29(5):397–403
von Meyenfeldt EM, van Keulen EM, Eerenberg JP, Hendriks ER (2010) The linea arcuata hernia: a report of two cases. Hernia 14:207–209
Abasbassi M, Hendrickx T, Caluwé G, Cheyns P (2011) Symptomatic linea arcuata hernia. Hernia 15(2):229–231
Rizk NN (1991) The arcuate line of the rectus sheath—does it exist? J Anat 175:1–6
Monkhouse W, Khalique A (1986) Variations in the composition of the human rectus sheath: a study of the anterior abdominal wall. J Anat 145:61–66
Cunningham SC, Rosson GD, Lee RH, Willians JZ, Lustman CA, Slezak S, Goldberg NH, Silverman RP (2004) Localization of the arcuate line from surface anatomic landmarks:a cadaveric study. Ann Plast Surg 53(2):129–131
Loukas M, Mayers C, Shah R, Tubbs RS, Wartmann C, Apaydin N, Betanor J, Jordan R (2008) Arcuate line of the rectus sheath: clinical approach. Anat Sci Int 83(3):140–144
Mwachaka PM, Saidi HS, Odula PO, Awori KO, Kaisha WO (2010) Locating the arcuate line of Douglas: is it of surgical relevance? Clin Anat 23(1):84–86
Skandalakis PN, Zoras O, Skandalakis JE, Mirilas P (2006) Spigelian hernia: surgical anatomy, embryology and technique of repair
Spangen L (1989) Spigelian hernia. World J Surg 13(5):573–580
Losanoff JE, Basson MD, Gruber SA (2009) Spontaneous hernia through the posterior rectus abdominis sheath: case report and review of published literature 1937–2008. Hernia 13:555–558
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Montgomery, A., Petersson, U. & Austrums, E. The arcuate line hernia: operative treatment and a review of the literature. Hernia 17, 391–396 (2013). https://doi.org/10.1007/s10029-012-0982-6
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DOI: https://doi.org/10.1007/s10029-012-0982-6