The linea alba is the vertical tendinous raphe formed by the decussating aponeuroses of the bilateral external oblique, internal oblique, and transversus abdominis muscles. It extends from the xiphoid process to the pubic symphysis, widening in the epigastrium and narrowing below the umbilicus. It provides structural midline continuity of the abdominal wall.
Epigastric hernias preferentially occur through defects in the linea alba, typically between the xiphoid and umbilicus where the linea is widest. Diastasis recti is widening of the linea alba above the umbilicus from pregnancy or obesity, identifiable clinically as a midline ridge during abdominal curls. Primary closure of the linea alba in laparotomy must account for fascial quality to prevent incisional hernia.
Peritoneal fat or bowel protrusion through a defect in the linea alba, producing a tender epigastric lump that is reducible and worsened by increased intra-abdominal pressure.
Widening of the linea alba from repeated abdominal distension, particularly in pregnancy, producing a visible midline bulge without true herniation, managed with core rehabilitation.
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