Case Report: Interparietal hernia due to posterior rectus sheath dehiscence following a Rives-Stoppa repair for a ventral hernia.

Introduction: Primary ventral abdominal wall hernias, especially when complicated by concomitant rectus abdominis diastasis, pose a complex challenge for surgeons. The retro-muscular Rives-Stoppa technique is a well-established and effective repair method. However, a rare but severe complication is the development of an interparietal hernia. Case presentation: We present the case of a 57-year-old male with an epigastric hernia and diastasis recti who underwent an open retro-muscular Rives-Stoppa repair. Postoperatively, he developed a series of non-specific symptoms including mild discomfort, nausea, and vomiting, without clear signs of hernia recurrence. On postoperative day four, his condition worsened with projectile bilious vomiting and acute kidney injury. A CT scan revealed an incarcerated interparietal hernia containing small bowel between the posterior rectus sheath and the mesh. He underwent an emergency reoperation to reduce the bowel and repair the defect. The patient had an uneventful recovery and was discharged on postoperative day seven. Discussion: Interparietal hernias are a rare complication of the Rives-Stoppa repair, resulting from dehiscence of the posterior rectus sheath. This can lead to incarcerated bowel without the external signs of a recurrent hernia, delaying diagnosis. High clinical suspicion and a low threshold for CT imaging are crucial. We review the current literature, highlighting the scarcity of reported cases and the various surgical approaches, which include open, laparoscopic, or expectant management. Conclusion: Although uncommon, interparietal hernia should be considered in any patient who fails to thrive after a Rives-Stoppa repair. This case emphasizes the need for prompt diagnosis and a tailored management strategy to prevent severe morbidity.