Spigelian hernia: a rare abdominal hernia

Spigelian hernia is a rare variety of abdominal wall hernia occurring through the spigelian fascia which is composed of the aponeurotic layer between rectus muscle medially and semilunar line laterally. Generally it is difficult to diagnose because of their location and non specific symptoms. Diagnosis is aided by ultrasonography and Computerized Tomography. Once the diagnosis is confirmed, it is repaired surgically as risk of incarceration is high. We reported this interesting case of spigelian hernia with associated port site hernia in a 53 year old female patient from Arwal district, Bihar who presented with occasional lower abdominal pain. The hernia was reduced and defect was repaired. Her recovery was uneventful.

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Spigelian hernia - an unusual abdominal hernia: a case report and review of literature

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20150898 ◽

2015 ◽

Vol 1 (5) ◽

pp. 239 ◽

Cited By ~ 3

Author(s):

Suman Saurav Rout ◽

Prakash Kumar Sahoo

Keyword(s):

Abdominal Wall ◽

Inguinal Canal ◽

Lower Abdominal Pain ◽

Operative Management ◽

Spigelian Hernia ◽

Abdominal Hernia ◽

Abdominal Wall Defects ◽

Review Of Literature ◽

Semilunar Line ◽

Specific Symptoms

Spigelian hernias are rare abdominal wall defects that occur at the semilunar line lateral to the rectus abdominis muscle. They are situated between the muscular layers of the abdominal wall and can be easily overlooked because of abdominal obesity. Generally difficult to diagnose because of their location and vague non-specific symptoms radiographic studies have been beneficial in confirming the diagnosis. The diagnosis has been considerably aided by the introduction of ultrasonography and Computed Tomography (CT). Once the diagnosis is made operative management is indicated due to chances of incarceration. We report a 48 years old patient from the IMS and SUM hospital, Bhubaneswar, Odisha, India who presented with colicky lower abdominal pain associated with a non-tender swelling above and lateral to the left inguinal canal. A diagnosis of Spigelian hernia was made and confirmed on exploration. The hernia was reduced and the defect repaired. His recovery was uneventful.

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Laparoscopic transabdominal preperitoneal repair of concurrent spigelian and groin hernias: a rare case

International Surgery Journal ◽

10.18203/2349-2902.isj20212749 ◽

2021 ◽

Vol 8 (7) ◽

pp. 2244

Author(s):

Aditya C. Oak ◽

Vishakha R. Kalikar ◽

Ankur K. Patel ◽

Roy V. Patankar

Keyword(s):

Abdominal Pain ◽

Mesh Repair ◽

Rare Case ◽

Lower Abdominal Pain ◽

Abdominal Wall Hernia ◽

Spigelian Hernia ◽

Preperitoneal Repair ◽

Rare Type ◽

Direct Hernia ◽

Groin Hernias

Spigelian hernia is a rare type of abdominal wall hernia due to congenital defect in the transversus aponeurosis fascia. It has a prevalence of 2%. Traditionally, an anterior hernioplasty was used to repair these defects. Only a few cases have been reported in the literature. Here we discuss a case of a 66 year old female with chronic lower abdominal pain with swelling in left inguinal area diagnosed with spigelian hernia on ct scan along with left direct hernia as well as left femoral hernia found incidentally and repaired using totally extra peritoneal single mesh repair.

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Spigelian Hernia: Surgical Anatomy, Embryology, and Technique of Repair

The American Surgeon ◽

10.1177/000313480607200110 ◽

2006 ◽

Vol 72 (1) ◽

pp. 42-48 ◽

Cited By ~ 41

Author(s):

Panagiotis N. Skandalakis ◽

Odyseas Zoras ◽

John E. Skandalakis ◽

Petros Mirilas

Keyword(s):

Rectus Muscle ◽

Abdominal Muscle ◽

Surgical Anatomy ◽

Spigelian Hernia ◽

Etiologic Factor ◽

Abdominal Muscles ◽

Line Defects ◽

Semilunar Line ◽

Neonates And Infants ◽

Wide Zone

Spigelian hernia (1–2% of all hernias) is the protrusion of preperitoneal fat, peritoneal sac, or organ(s) through a congenital or acquired defect in the spigelian aponeurosis (i.e., the aponeurosis of the transverse abdominal muscle limited by the linea semilunaris laterally and the lateral edge of the rectus muscle medially). Mostly, these hernias lie in the “spigelian hernia belt,” a transverse 6-cm-wide zone above the interspinal plane; lower hernias are rare and should be differentiated from direct inguinal or supravescical hernias. Although named after Adriaan van der Spieghel, he only described the semilunar line (linea Spigeli) in 1645. Josef Klinkosch in 1764 first defined the spigelian hernia as a defect in the semilunar line. Defects in the aponeurosis of transverse abdominal muscle (mainly under the arcuate line and more often in obese individuals) have been considered as the principal etiologic factor. Pediatric cases, especially neonates and infants, are mostly congenital. Embryologically, spigelian hernias may represent the clinical outcome of weak areas in the continuation of aponeuroses of layered abdominal muscles as they develop separately in the mesenchyme of the somatopleura, originating from the invading and fusing myotomes. Traditionally, repair consists of open anterior herniorraphy, using direct muscle approximation, mesh, and prostheses. Laparoscopy, preferably a totally extraperitoneal procedure, or intraperitoneal when other surgical repairs are planned within the same procedure, is currently employed as an adjunct to diagnosis and treatment of spigelian hernias. Care must be taken not to create iatrogenic spigelian hernias when using laparoscopy trocars or classic drains in the spigelian aponeurosis.

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Giant Ovarian Tumor Presenting as a Huge Abdomino-Pelvic Mass in a Teenage Girl: A Case Report

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v39i2.52394 ◽

2021 ◽

Vol 39 (2) ◽

pp. 137-141

Author(s):

Muhammad Jamaluddin ◽

Hajrah Hilal Ahmed

Keyword(s):

Abdominal Pain ◽

Case Report ◽

Ovarian Tumor ◽

Abdominal Cavity ◽

Lower Abdominal Pain ◽

Pelvic Mass ◽

Interesting Case ◽

Ovarian Cysts ◽

Teenage Girl ◽

Common Causes

Ovarian cysts are common causes of lower abdominal pain and abdominal distention in females. While most of them are benign and rarely grow immensely to achieve a huge size, they may be neoplastic in origin, reaching enormous dimensions with minimum or without raising any symptoms.Here, we present an interesting case of a 19-year-old female,who presented with huge abdominal swelling and pain in whole abdomen from whom a 9.1 kg borderline mucinous ovarian cyst, occupying the whole abdominal cavity was removed. J Bangladesh Coll Phys Surg 2021; 39(2): 137-141

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Adult Colo-Colic Intussusception Induced By a Lipoma Masquerading As a Sigmoid Polyp on Colonoscopy: A Case Report

Journal of Shaheed Suhrawardy Medical College ◽

10.3329/jssmc.v5i1.16226 ◽

2013 ◽

Vol 5 (1) ◽

pp. 72-74

Author(s):

Junaid Nabi ◽

SM Quamrul Akhter ◽

Mohammad Abdullah Al Mamun ◽

Nelema Jahan ◽

Md Mamunur Rahman

Keyword(s):

Abdominal Pain ◽

Case Report ◽

Preoperative Diagnosis ◽

Anal Verge ◽

Lower Abdominal Pain ◽

Histological Evaluation ◽

Midline Incision ◽

History Of ◽

Specific Symptoms ◽

Satisfactory Recovery

Intussusception in adults is rare, accounting for only 5% of all cases of intussusceptions and only 1% of bowel obstruction. Preoperative diagnosis is often difficult due to non specific symptoms and subacute nature. This case report was a per-operatively diagnosed adult colo-colic intussusception induced by a lipoma which mimicked a sigmoid polyp on colonoscopy. A 40-year-old Bengali woman was admitted with two weeks history of colicky lower abdominal pain. Ultrasound abdomen was unremarkable. Colonoscopy revealed a moderately enlarged sigmoid polyp at 25 cm from the anal verge. A midline incision laparotomy was performed only to reveal a colo-colic intussusception. The intussusception was reduced and the patient underwent a segmental resection of the involved bowel. Histological evaluation confirmed the diagnosis of lipoma of the colon. The patient however satisfactory recovery and remains well six months after surgery. DOI: http://dx.doi.org/10.3329/jssmc.v5i1.16226 J Shaheed Suhrawardy Med Coll, 2013;5(1):72-74

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A Man With Recurrent Lower Abdominal Pain: Spigelian Hernia

Surgical Laparoscopy Endoscopy & Percutaneous Techniques ◽

10.1097/sle.0b013e3181570db9 ◽

2008 ◽

Vol 18 (1) ◽

pp. 106-108 ◽

Cited By ~ 7

Author(s):

Kwok-Kay Yau ◽

Wing-Tai Siu ◽

Ka-Leung Chan ◽

Ka-Wah Michael Li

Keyword(s):

Abdominal Pain ◽

Lower Abdominal Pain ◽

Spigelian Hernia

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Traumatic Abdominal Hernia Masquerading as Strangulated Spigelian Hernia

Panamerican Journal of Trauma, Critical Care & Emergency Surgery ◽

10.5005/jp-journals-10030-1124 ◽

2015 ◽

Vol 4 (2) ◽

pp. 103-106

Author(s):

Malarvizhi Chandrasekhar ◽

Jim Jebakumar ◽

D Nagarajan ◽

Aravind Menon

Keyword(s):

Abdominal Wall Hernia ◽

Exploratory Laparotomy ◽

Operative Management ◽

Spigelian Hernia ◽

Abdominal Hernia ◽

Anatomical Site ◽

Resection And Anastomosis ◽

High Degree ◽

Traumatic Abdominal Hernia ◽

Rare Hernia

ABSTRACT Spigelian hernia is a rare hernia constituting 0.1 to 2% of all hernias and needs high degree of clinical suspicion to diagnose. It has high chances of strangulation and hence operative management is advised. Traumatic abdominal wall hernia (TAWH) is yet another type of rare hernia usually occurring due to blunt trauma. This patient presented with TAWH with features of strangulation, at the anatomical site of Spigelian hernia mimicking a strangulated Spigelian hernia. He underwent emergency exploratory laparotomy, resection and anastomosis of involved small bowel segment with anatomical repair of defect. Patient recovered uneventfully in postoperative period. How to cite this article Nagarajan D, Chandrasekhar M, Jebakumar J, Menon A. Traumatic Abdominal Hernia Masquerading as Strangulated Spigelian Hernia. Panam J Trauma Crit Care Emerg Surg 2015;4(2):103-106.

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A case of incarcerated spigelian hernia causing small bowel obstruction

International Surgery Journal ◽

10.18203/2349-2902.isj20205392 ◽

2020 ◽

Vol 7 (12) ◽

pp. 4238

Author(s):

Ravi Kumar Sabu Murugesan ◽

Kannan Ross ◽

Joyce Prabakar

Keyword(s):

Abdominal Pain ◽

Case Report ◽

Small Bowel ◽

Physical Examination ◽

Abdominal Wall ◽

Anterior Abdominal Wall ◽

Spigelian Hernia ◽

Obese Patients ◽

Rectus Abdominis Muscle ◽

Semilunar Line

Spigelian hernias are rare anterior abdominal wall hernias in which the defect occur at the semilunar line lateral to rectus abdominis muscle. It mostly occurs in the lower half as posterior sheath is deficient in that region. Spigelian hernias are rare and moreover it is difficult to diagnose clinically. It constitutes about 0.12% of abdominal wall hernias. Even though it is rare, it is more prone for complications. It affects both sexes and sides equally. It is a diagnostic difficulty especially in obese patients as in our case where physical examination will often be inconclusive. Majority of the spigelian hernias are diagnosed intra operatively. Here in this case report, we present a case of obese 48 years old female who presented with abdominal pain and signs of intestinal obstruction which was found out to be an incarcerated spigelian hernia. Recently laparoscopic repair has been found to be safe and effective.

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