Presentation
Hematuria for investigation. A CT urinary tract with contrast was requested.
Patient Data
There is a well defined mildly enhancing exophytic right renal mass with a further right adrenal mass.
Incidental finding of splitting of the posterior sheath of left-sided rectus abdominus muscle with herniation of bowel loops through the defect, yet there is no bowel obstruction.
Small simple left renal cysts are noted.
These annotated images demonstrate the splitting of the posterior sheath on the left side with intact sheath on the right , it also shows where the bowel loops go through the defect. It is an interparietal hernia with the hernial sac unusually doesn't exit into the subcutaneous tissue as other hernias do.
Case Discussion
Posterior rectus sheath hernias are rare hernia of the anterior abdominal wall where the hernial sac lies between the various layers of the abdominal wall muscles and does not exit into the subcutaneous tissue.
The right renal mass has been discussed in the urology MDT, and they advised CT follow up after 6 months as the patient is elderly.
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