New data of topographic anatomy of semilunar line (semilunar line by A. Spiegel)

Background. Today, a special place in surgical practice is the treatment of patients with spigelian hernias, which can be subcutaneous, interstitial, prepperitoneal, and make up 1% of all external hernias of the abdomen. The difficulty in diagnosing of spigelian hernias can lead to a serious complication – infringement of the hernia, which will require emergency surgical treatment. Therefore, the study of the typical, sexual and variant anatomy of the Spigelian line region is important in improving the diagnosis and treatment of such patients.The aim. To study the features of typical, sexual and variant anatomy of the Spigelian line region.Materials and methods. We examined 42 non-fixed corpses of persons of both sexes without signs of pathology of the anterior abdominal wall. Among them were 26 (54.2%) men and 22 (45.8%) women. At autopsy, we performed anatomical dissection of the semilunar line region. We measured the width of the aponeurotic stretch from the end of the transverse abdominal muscle fibers to the lateral edge of the rectus abdominis muscle at level corresponding to d. bicostarum, umbilical ring and d. bispinarum.Results. We identified four clusters corresponding to the variations in the shape of the semilunar line: tapering down (9.5%), uniform wide (19.0%), tapering up (28.6%) and wide in the middle (42.9%). We found that the semilunar line, tapering up, was significantly more often observed in women (83.3%), uniformly wide – in brachymorphic body type (75.0%), wide in the middle – in mesomorphic body type (66.07%), and the semilunar line, tapering down, was found only in men. Variants of the shape of the semilunar line, tapering up or down, were absent in persons of the brachymorphic body type. Semilunar line, tapering up, was found (without significant differences) in persons of the mesomorphic body type in 41.6%, in the persons of the brachymorphic body type – in 58.4%, and semilunar line, tapering down, was noted in persons with a dolichomorphic body type in 75.0%.Conclusion. New data may allow to predict the location, type of spigelian hernia, and also improve the diagnosis and treatment of spigelian hernia.

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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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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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Technical Aspects in Studying Peritoneal Morphology in Animal Models of Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686080902902s07 ◽

2009 ◽

Vol 29 (2_suppl) ◽

pp. 40-44 ◽

Cited By ~ 3

Author(s):

Soner Duman ◽

Sait Şen

Keyword(s):

Peritoneal Dialysis ◽

Abdominal Wall ◽

Histological Examination ◽

Anterior Abdominal Wall ◽

Anterior Wall ◽

Abdominal Muscle ◽

Tissue Samples ◽

Peritoneal Tissue ◽

Significant Difference ◽

Peritonitis Model

Objective Peritoneal biopsies are considered useful for gaining a better understanding of the pathophysiology of the peritoneum during experimental peritoneal dialysis (PD). Different peritoneal tissue samples (i.e., abdominal wall, liver, diaphragm, intestine, and omentum) may be used, but there can be artifacts due to peritoneal tissue processing. Aim To investigate differences in peritoneal membranes from different parts of the peritoneum, and also 2 different fixatives, in experimental PD and a peritonitis model in rats. Methods Peritoneal tissues from the anterior abdominal wall, liver, omentum, and intestine were taken from each of 3 groups of animals: sham, experimental PD, and peritonitis model. Tissue samples were immediately fixed with 4% formaldehyde and routinely processed for histological examination. Two parietal peritoneal tissue samples according to longitudinal and horizontal sections of anterior wall inner abdominal muscle were also taken. All samples were immediately fixed with 4% formaldehyde and B5 fixative (B5), and then routinely processed for histological examination. Results In all groups, histopathological findings were more commonly seen in the abdominal wall samples. There were no changes observed in peritoneal membranes other than those of anterior abdominal wall samples from both sham and PD model rats. However, there was a significant difference between anterior and posterior facets of liver in the peritonitis model. Furthermore, the antimesenteric site of intestinal peritoneum was less affected than the mesenteric site. There were no significant histopathological differences between B5 and 4% formaldehyde fixation ( p > 0.05). Conclusion Our results suggest that peritoneum obtained from the anterior abdominal wall is the most affected area and therefore the most suitable site to investigate peritoneal changes in the experimental rat PD model. There were no significant differences between fixation with 4% formaldehyde and B5 solution. Abdominal wall samples should be of the same direction of inner abdominal muscle, that is, horizontal sectioning should be used for measurements of the submesothelial area.

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Spigelian hernia-Our experience

JMS SKIMS ◽

10.33883/jms.v21i2.357 ◽

2019 ◽

Vol 21 (2) ◽

pp. 114-116

Author(s):

Ajaz A Malik ◽

Shams Ul Bari

Keyword(s):

High Risk ◽

Clinical Presentation ◽

Spigelian Hernia ◽

Abdominal Muscles ◽

Medical College ◽

Semilunar Line ◽

Rare Hernia

Background; A Spigelian hernia is a very rare hernia which develops through the aponeurotic layer between the rectus abdominal muscles medially, and the semilunar line laterally. Aim: The aim of this study is to understand the clinical presentation and management of this rare hernia. Material and methods: This study was conducted over a period of five years in the Department of Surgery SKIMS Medical College Srinagar and included all the patients diagnosed as spigelian hernia. Results: During our study, we encountered only four cases of spigelian hernia, which included three females and one male. Conclusion: The spigelian hernia is a very rare hernia seen in adults and usually there is no notable swelling on examination. Although they are rare but there is a high risk of strangulation. JMS 2018: 21 (2):114-116

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The Effect of Selected Exercise Programs on the Quality of Life in Women with Grade 1 Stress Urinary Incontinence and Its Relationship with Various Body Mass Indices: A Randomized Trial

BioMed Research International ◽

10.1155/2020/1205281 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Magdalena Ptak ◽

Sylwester Ciećwież ◽

Agnieszka Brodowska ◽

Aleksandra Szylińska ◽

Andrzej Starczewski ◽

...

Keyword(s):

Quality Of Life ◽

Urinary Incontinence ◽

Stress Urinary Incontinence ◽

Body Mass ◽

Randomized Study ◽

Abdominal Muscle ◽

Body Type ◽

International Consultation ◽

Before And After

Aims. The aim of the study was to analyze the influence gymnastics has on the quality of life (QOL) in women with grade 1 stress urinary incontinence (SUI) and to determine the relationship between the outcome and selected body weight indices: body mass index (BMI) and waist-to-hip ratio (WHR). Methods. A randomized study of 140 women (45-60 years) with grade 1 SUI. The subjects were randomly assigned to a 3-month training for pelvic floor muscles and a transverse abdominal muscle (PFM + TrA, n=70) or PFM alone (n=70). The QOL was determined with the questionnaire International Consultation on Incontinence Modular Questionnaire–Lower Urinary Tract Symptoms Quality of Life (ICIQ LUTS QOL), before and after the program. Results. Women with BMI<30 kg/m2 benefited more from the PFM + TrA program with respect to physical limitations and embarrassment domains, whereas patients with a gynoid body type (WHR<0.8) benefited more in terms of physical and social limitations, SUI-evoked emotions, severity measures, and embarrassment domains. Conclusions. After the PFM + TrA training, women with WHR<0.8 had a better QOL than those with WHR>0.8.

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Spigelian hernia

Kathmandu University Medical Journal ◽

10.3126/kumj.v8i2.3567 ◽

1970 ◽

Vol 8 (2) ◽

pp. 241-243 ◽

Cited By ~ 2

Author(s):

TP Bhatia ◽

P Ghimire ◽

ML Panhani

Keyword(s):

High Risk ◽

Spigelian Hernia ◽

Rare Type ◽

Prolene Mesh ◽

Diffi Cult ◽

History Of ◽

Semilunar Line ◽

History Of Pain ◽

Lateral Ventral Hernia ◽

Symptoms And Signs

A Spigelian hernia (or lateral ventral hernia) is a hernia through the spigelian fascia, which is the aponeurotic layer between the rectus abdominis muscle medially, and the semilunar line laterally. So far, about 1000 cases have been reported worldwide. These hernias are diffi cult to diagnose as they do not present with a subcutaneous swelling and have high risk of going for strangulation. We discuss the case of a 36 year old female who presented with history of pain and lumpiness in left lower abdomen, both of which decreased on lying down. She presented to emergency with an episode severe pain at same site which subsided spontaneously. Diagnosis was confirmed on C T scan, plication and onlay prolene mesh repair performed. Spigelian hernias are rare, interparietal type of hernias which have high risk undergoing strangulation. Knowledge of symptoms and signs is vital to diagnosis and treatment of these rare type of hernias. Key words: Spigelian hernia; Interparietal hernia; Rare hernias DOI: 10.3126/kumj.v8i2.3567 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 241-243

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The Aorta

Interventional Radiology ◽

10.1093/med/9780190276249.003.0018 ◽

2018 ◽

pp. 199-218

Author(s):

Kyle J. Cooper ◽

Constantino S. Peña ◽

James F. Benenati

Keyword(s):

Disease Management ◽

Aortic Wall ◽

Aortic Injury ◽

The Body ◽

Diagnosis And Treatment ◽

Arterial Blood ◽

Common Process ◽

Variant Anatomy

The aorta is the primary conduit delivering arterial blood from the heart to the rest of the body. Understanding its formation and development is essential to explaining its variant anatomy. The aorta can be involved in a large number of conditions. Atherosclerosis is the most common process that affects the aorta. In addition, acute aortic injury can lead to ulceration, dissection, rupture, and transection. Genetic and hereditable conditions involving the aorta are conditions that can cause a number of changes to the structural makeup of the aortic wall. Understanding these condition allows their proper recognition, diagnosis, and treatment. This chapter, therefore, will review the anatomy, pathophysiology, and disease management related to the aorta.

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Computed tomographic colonography: Diagnosis of an incarcerated Spigelian hernia

South African Journal of Radiology ◽

10.4102/sajr.v18i1.673 ◽

2014 ◽

Vol 18 (1) ◽

Author(s):

Joel H. Bortz

Keyword(s):

Small Bowel ◽

Abdominal Wall ◽

Anterior Abdominal Wall ◽

Abdominal Wall Hernia ◽

Abdominal Discomfort ◽

Spigelian Hernia ◽

Computed Tomographic Colonography ◽

Rare Form ◽

Lateral Deviation ◽

Computed Tomographic

A 68-year-old obese man underwent computed tomographic colonography (CTC) scanning to investigate worsening constipation and lower abdominal discomfort on his left side.Optical colonoscopy was contraindicated because of his comorbidities. A preliminary CTC diagnosis of incarcerated Spigelian hernia was made, based on lateral deviation of thesigmoid colon to the left as well as extrinsic impressions on it, and the central location of the small bowel. Spigelian hernia is a rare form of anterior abdominal wall hernia. CTC can play a role in its diagnosis.

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