Anterior abdominal wall 'peritoneal recess'

Published Date: 19th July 2016

Publication Authors: Samad A

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Background

No clear guidelines exist about management of chronic abdominal pain. We present here a new potential space named as ‘Peritoneal Recess’ inside the abdomen which was found during diagnostic laparoscopy performed to look for the cause of recurrent abdominal pain.

Material and Methods

A middle aged patient presented with intermittent chronic abdominal pain without any obvious cause. All her investigations including small bowel studies were normal; however a recent CT scan raised the suspicion of an intra-abdominal hernia. A diagnostic laparoscopy was performed to repair the CT detected hernia; though there was no obvious lump on examination.

Result

Laparoscopy revealed a left sided unilateral ‘Peritoneal Recess’ formed by a fold of peritoneum lying medial to linea-semilunaris and conforming to the curve of arcuate line for approximately 2.5 cm ending up in a blind recess (Pics taken). No extra-peritoneal sac or defect was noted neither in the rectus sheath nor any contents were present in the recess at the time of laparoscopy. It seemed like the bowel was getting intermittently trapped inside the recess leading to partial kinking causing recurrent abdominal pain. By definition this is not a true hernia and we have named it as “Samad-Siddique’s pseudo-hernia”. The ‘Peritoneal Recess’ was closed with laparoscopic tackers to prevent bowel from further entering the ‘Recess’ which helped resolving the patient symptoms.

Conclusion

The ‘Peritoneal Recess’ may cause pseudoherniation of small bowel resulting in chronic abdominal pain. We recommend diagnostic laparoscopy for confirmation followed by endoscopic fixation.

Siddique, K; Samad, A. (2014).  Anterior abdominal wall 'peritoneal recess': Rare cause of recurrent bowel obstruction due to pseudo herniation . European Surgical Research. 52 (3-4), 166.

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