Button hole defects of posterior rectus sheath : A real problem in patients with higher order repeat cesarean deliveries.

When patients undergo higher order cesarean deliveries, the common problem noticed by me is a " button hole defect" of the posterior rectus sheath. This happens because,  each time a woman undergoes cesarean delivery, her rectus sheath is cut and usually this does not require approximation.  So for every repeat cesarean, the rectus sheath becomes weaker and weaker. If such defects are not looked for carefully,  then few weeks later patient will present with do lower abdominal pain with swelling in the abdomen.  The b examination or a CT scan will confirm incisional hernia.