Posterior Rectus Sheath Hernia Causing Chronic Abdominal Pain

Posterior rectus sheath hernias are rare hernias that can be difficult to diagnose due to unreliable physical exam characteristics and subtle radiological findings. We present an interesting case of an elderly female found to have a posterior rectus sheath hernia during a diagnostic laparoscopy for chronic abdominal pain. CT evaluation revealed possible appendicitis and laxity of the abdominal wall of the right lower quadrant. Intraoperatively, a 4 cm hernia defect in the right lateral abdominal wall was appreciated. Appendectomy and herniorrhaphy with mesh repair were performed. Postoperative review of CT imaging and intraoperative photographs determined that this hernia defect is a posterior rectus sheath hernia likely caused by trocar placement from previous laparoscopic surgery. This report contributes to the limited body of the literature for this rare type of hernia. Posterior rectus sheath hernias should be considered in differential diagnoses for patients presenting with chronic abdominal pain without clear etiology.