DISORDERS OF THE RECTUS-ABDOMINIS MUSCLE AND SHEATH - A 22-YEAR EXPERIENCE

Objectives: 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. Method: A retrospective medical record review of RMS disorders seen at The New York Hospital-Cornell Medical Center from 1971 to 1992. Results: A total of 40 patients with disease s 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 sigmo id carcinoma, gallbladder empyema, and disseminated actinomycosis. Ele ven of 18 patients with desmoid tumors had familial adenomatous polypo sis (FAP). The desmoid tumors in patients with FAP resulted in greater morbidity and mortality than those in patients without FAP. All patie nts with hematomas were on anticoagulation or had a history of trauma, vigorous coughing, or physical exertion. Conclusions: 1) RMS disease should be suspected in patients with a palpable abdominal mass and a h istory of familial adenomatous polyposis, trauma, anticoagulation, or vigorous coughing or exercise, 2) The most common nonneoplastic condit ion of the RMS is a hematoma, 3) The desmoid tumor is the most common neoplasm of the RMS, 4) Abdominal ultrasonography and CT readily disti nguish RMS disease from intraabdominal pathology.