Divarication of rectus abdominis

[Linh]

Dear Steve,

Hope you’ve been well.

I was wondering what is your criteria for diagnosing Divarication? I used 50mm as the cutoff but it seems that sometimes, when the patient hunches down, I can still see linea alba bulging even though the interrectus distance may not necessarily be 50mm. Normally, there shouldn’t be any bulging?

Best regards,
Linh

[Stephen Bird]

Hi Linh,

I don’t get too carried away with the actual measurement,

I think a clinical examination provides a good assessment.

I look for the presence of ventral hernia formation and look at the echogenicity of the rectus abdominus muscles as well as the TA, IO and EO muscles of the lateral abdominal wall looking for atrophy changes.

I measure and report the width of the linea alba but accept there is a wide range of normal depending on age, parity etc.

The anterior bulging is also a clinical diagnosis I think,

Steve

[Linh]

Hi Steve,

Thanks for you reply.

I do agree there is a range as I have seen a child being diagnosed with divarication when you see the midline vertical bulging.

It is obvious when you see it clinically, but for mild cases, I just want to get this idea clear.
So normally, when the patient hunches over when supine, the Rectus should come together and there should be no bulging of linea alba at all? Because if there is, then we call it divarication?

Best regards,
Linh

[Stephen Bird]

Hi Linh,

I think it depends on who you believe. I see numbers published from 20mm to 50mm and I think some common sense is required. Certainly if there is any anterior bulging of the linea alba during straining this is diagnostic.

I have attached an article for you,

Steve

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[Linh]

Thanks Steve!

[Author]

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