Occurrence of Diastasis of the Rectus Abdominis Muscles in Patients with Medial Pectus Excavatum

Abstract

Background: Since 1994, we have used soft silicone blocks sculpted intraoperatively to correct pectus excavatum in male patients. This technique involves a horizontal access incision in the region of the lower edge of the sternum. During the dissection to expose the sternum, we observed a constant diastasis of the rectus abdominis muscle and changes of the anatomy at its superior insertion. There is no report on this association. Methods: Male patients with untreated medial pectus excavatum with indication for silicone block correction were enrolled. Age, weight, height, and the presence of other associated conditions were noted. Ultrasound examination was performed. During the surgery, the width of the linea alba was evaluated and the anatomical positioning of the insertion of rectus abdominis muscle was noted. Results: From 2017 to 2019, 10 patients were submitted to surgery. The mean age was 27 years. All patients presented diastasis at the preoperative physical examination. Imaging examination reports showed diastasis of the rectus abdominis muscle: seven partial epigastric separations and three total separations, two of which were associated with umbilical hernia. The intraoperative findings showed the line alba with a minimum of 23 mm and a maximum of 45 mm width at 4 cm from the xiphoid process edge. The muscle borders presented a curved lateral deviation up to the insertion in the costal arches with a distance ranging from 35 mm to 60 mm. Conclusions: This study confirms the anatomical alterations of the superior portion of the rectus abdominis muscle. The authors discuss the surgical consequences and suggest that the semiology of rectus abdominis muscle is an important preoperative action in pectus excavatum patients.

The correction of the diastasis of the rectus abdominis muscle concomitant with a moulded silicone implant insertion in a patient with medial pectus excavatum

“…Descriptions of the physical aspect of the medial PE focus on the depressed position of the sternum and the final costal arches and emphasize a ‘typical pectus posture’, illustrated by a forward-wrapping curvature, a relative prominence of the lower costal arches, and a configuration of the depressed abdomen in continuation with the PE, which becomes more prominent towards the hypogastrium [ 1 ]. The separation of RAMs in continuity with the sternum cavity associated with a patient’s posture may highlight the appearance of the depression even more [ 3 ]. The case we present may indicate the necessity to re-evaluate the muscular changes and surgical procedures, and possibly include the muscular surgical assessment to improve the aesthetic result.…”