Based on these ct photos, do I have a hernia, diastasis recti or both? (photos)

Question

I've gotten 3 different answers from 3 different general surgeons. I'm 10 weeks postpartum via csection. 1st surgeon said he didn't feel a hernia it's just muscle weakeness if there is one its small 2nd one said hernia is about 4-5 inches wait a few more months and 3rd said he can do the surgery now. But neither showed me my ct scan and specifically showed me the hernia. Just a bit confused on what to do. Thank you

Dean Trotter, MBBS, FRACS · Answer

Based on your CT scan I agree that you do have a ventral hernia, due to divarication (diastasis) of your rectus abdominus muscle.  Most likely this is related to your recent pregnancy.I think this is unlikely to resolve with time, exercises to strengthen the muscles or compression garments to try to pull things back together.  Most likely you will need a repair of the divarication and this is most easily and safely performed as part of an abdominoplasty.  I suggest waiting a few more months before you undertake the surgery.  It is ideal if you have returned to your pre-pregnancy weight and activity levels.  If you are planning more children it is also probably better to defer the surgery until after your last child too.Kind regards,Dean

Paul Vitenas, Jr., MD · Answer

Thank you very much for your
question and photographs.  Your CT scan
shows a large, ventral diastasis recti (abdominal separation), and you will
most probably want to have this repaired. 
However, there is a fundamental difference between a diastasis recti and
a ventral hernia.  A hernia is a hole,
completely through the fascia (connective tissue), which allows the contents of
the abdominal cavity to escape out of.  A
diastasis is just a weakening and thinning of the fascia.  I would suggest that you wait six months and
then see an experienced Board Certified plastic surgeon.  He/she can fix this, along with doing a tummy
tuck, giving you a pleasant looking scar and an aesthetically pleasing
result.

Emmanuel Mallol Cotes, MD · Answer

Hi, thanks for your interesting question. I can see an important diastasis of abdominal rectus muscle in the CT scan. For practical purposes, it shows a similar behaviour of an hernia, because of this, In addition to a surgical muscle repair I recommend you the use of a proline net, which will give you a reinforcement to the abdominal wall. Respectfully,Dr. Emmanuel Mallol Cotes

Gregory T. Lynam, MD · Answer

Wow that CT scan  looks like rectus diastasis to me. I wonder how much it cost since physical exam is all most doctors need to diagnose this. If a general surgeon desires to fix this under your insurance plane then I bet you will not like the probable vertical scar. I agree that waiting and seeing a local board certified plastic surgeon is a good idea. If you elect to have this done now you may need it done again if you have other children. Good Luck!

Christopher J. Morea, MD · Answer

Thank you for your question.  Although I am not a radiologist, I do not see a hernia on your CT scan and I believe you have a diastasis recti.  As you are two and a half months post partum, I would recommend waiting another one to two months before considering having surgery.  If you are considering having more children, I would recommend waiting before having this repaired.  Correction of diastasis recti is a component of abdominoplasty procedure.  If you are done having children then I think you could safely proceed with an abdominoplasty within two to three months.

Darryl J. Blinski, MD · Answer

Agree with all previous posters. Very early to have had a CT of the abdomen, why was this ordered? We are not radiologists who read these CT's everyday, but appears as ONLY large diastasis. Best to allow full recovery for the next 3 months from your pregnancy...Than seek in person PS opinions.. Are you trying to obtain insurance coverage for a hernia since diastase is NOT a covered benefit?? Hummmmmmm

Remus Repta, MD · Answer

Thank you for the question and the CT images.  I dont think it matters much whether you have a hernia or a severe for of diastasis.  Where one ends and other begins may not be that easy to determine.  Furthermore, repair of either is actually going to look a lot alike.  Aesthetically, to avoid a vertical incision, a low horizontal incision near your pubic bone will be used to access the abdominal wall.  Repair of the abdominal wall will vary form surgeon to surgeon but bringing together the rectus muscles will be the end goal.  Some may use dermal matrix on top of the repair as an added safety but its not likely that it will be needed.  If you have loose abdominal skin or stretch marks this would also be a good time to combine  tummy tuck with the hernia repair.All the best,Dr. Remus Repta

Jourdan Gottlieb, MD · Answer

The CT's are quite small in size and hard to evaluate.  There is at least a diastasis.A radiologist who is specifically trained in evaluating the scan has undoubtedly read this, and the official reading based on looking at all the images will trump any online opinion. You can get the report by calling the imaging center where the study was performed. A proper diagnosis is made by a combination of history, physical exam, and review of imaging.  All the best.

Based on these ct photos, do I have a hernia, diastasis recti or both? (photos)

Answers (8)

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