Spigelian Hernia: A Rare Hernia With Peculiar Anatomy. (Case Report And Review Of Literature)

Background: Spigelian hernia best described as spontaneous lateral ventral hernia is an extremely rare type of hernia. The anatomical peculiarities and diagnostic challenges need to be understood in order to surgically mange this hernia. Introduction: Spigelian hernia occurs through a defect in the spigelian fascia typically lying in the spigelian zone. Case report: A case of a large incarcerated spigelian hernia is presented to highlight the diagnostic and anatomical peculiarities of this hernia. Discussion: The anatomical basis of this hernia along with clinical presentation, diagnostic modalities and treatment options is discussed. Conclusion: Clinical suspicion confirmed by imaging is necessary for diagnosis. Surgery is the mainstay of treatment.

Spigelian hernia

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