What is the most likely diagnosis for a postmenopausal woman with a midline abdominal mass that increases in size with Valsalva maneuver, 6 years after TAH (total abdominal hysterectomy) and BSO (bilateral salpingo-oophorectomy) for uterine sarcoma?

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Last updated: March 31, 2025 • View editorial policy

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Differential Diagnosis

  • The patient's presentation of an abdominal mass that increases in size with Valsalva maneuver is suggestive of a hernia.
  • The presence of a large, vertical midline abdominal scar consistent with her prior surgery also supports this diagnosis.

Single most likely diagnosis

  • Incisional hernia: This is the most likely diagnosis given the patient's history of prior abdominal surgery and the presence of a midline mass that increases in size with Valsalva maneuver. The fact that the mass is nontender and has been gradually increasing in size over the past month also supports this diagnosis.

Other Likely diagnoses

  • Ventral hernia: This is another possible diagnosis, as it can also present as a midline mass that increases in size with Valsalva maneuver. However, the presence of a prior surgical scar makes incisional hernia more likely.
  • Omental hernia: This is a type of hernia that occurs when a portion of the omentum protrudes through a defect in the abdominal wall. It can present as a palpable mass, but it is less likely than incisional hernia given the patient's history.

Do Not Miss

  • Recurrence of uterine sarcoma: Although the patient has had no weight loss, nausea, vomiting, or changes in bowel patterns, it is essential to consider the possibility of recurrence of her prior cancer, especially given the presence of an abdominal mass. This diagnosis would have significant implications for her treatment and prognosis.
  • Bowel obstruction: Although the patient has normal bowel sounds and no rebound or guarding, it is crucial to consider the possibility of bowel obstruction, especially if the hernia is incarcerated or strangulated.

Rare diagnoses

  • Desmoid tumor: This is a rare type of tumor that can occur in the abdominal wall, especially in patients with a history of prior surgery. It can present as a palpable mass, but it is much less likely than incisional hernia.
  • Lipoma: This is a type of benign tumor that can occur in the abdominal wall, but it is less likely to increase in size with Valsalva maneuver.

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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