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Spigelian hernia is a rare type of abdominal hernia; diagnosis is primarily through computed tomography, which is crucial for accurate diagnosis and planning early surgical intervention to preserve the herniated sac's contents., (© 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.)

Introduction and Importance: Traumatic Spigelian hernias, an unusual subtype of traumatic abdominal wall hernias (TAWH). This case highlights the individualized surgical management of Spigelian hernia depending on the presentation, history, and existence of concurrent intra-abdominal injuries. This case report, presented in line with the SCARE criteria, highlights a case of obstructed Spigelian hernia., Case Presentation: We present a 37-year-old male patient involved in a free fall from a coconut tree while harvesting fruits. A sharp branch injured the scrotum before he landed on the ground. Then he started presenting with abdominal pain, failure to pass stool, abdominal distention, and later on vomiting. Abdominopelvic CT-scan showed ventral hernia concealed at the right lower quadrant of the abdomen with proximal intestinal dilatation. Exploratory laparotomy was done along with Spigelian hernia repair., Clinical Discussion: This case was atypical, lacking evidence-based guidelines on surgical treatment. Considering the emergency aspect of the case, we performed an exploratory laparotomy along with hernia repair. The scrotal wound was cleaned and left open. The postoperative follow-up was conclusive, as the patient recovered with the hernia tract having healed by fibrosis., Conclusion: Spigelian hernia can be caused by trauma and may be difficult to diagnose at first glance. The attention should be paid to a thorough clinical examination and adequate workup. The surgical intervention may depend on intraoperative findings if done on an emergency basis., Competing Interests: Conflict of interest statement Hervé Tshikomba Mbuyamba reports financial support from Else Kröner-Fresenius Foundation through BEBUC Schorlarship Program to sponsor his master of medicine in General Surgery at Muhimbili University of Health and Allied Sciences. However, the authors declare that there is not competing interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Spigelian hernias are among the rare primary ventral hernias. Diagnosis is often difficult, as many cases are asymptomatic. Spigelian and inguinal hernias are usually considered separately in current scientific literature. With this case series, we want to illustrate a possible relationship between the neighboring hernia types., Methods: In this article, we report on a case series of Spigelian hernias that were operated on in five hernia centers in the period from January 1st, 2021 to October 31st, 2023. We have summarized all patient characteristics with previous operations and the result of the secondary operation., Results: We report a case series with 24 Spigelian hernias, 15 of which have a connection to previous inguinal hernias. In these cases, however, it is not certain whether these are primarily overlooked or occult hernias or whether these Spigelian hernias have arisen secondarily, as a result of previous hernia surgery. With this case series, we would like to point out a possible connection between Spigelian hernia and inguinal hernia. Further studies are needed to shed more light on this entity and explain its genesis., (© 2024. The Author(s).)

Scrotal and penile edema is a noninfectious complication of peritoneal dialysis (PD). A tear in the Spigelian fascia is occasionally recognized as a Spigelian hernia. However, there is no documented evidence that this is a contributing factor for scrotal edema in individuals undergoing PD. We encountered a case of scrotal edema in a patient undergoing PD due to bilateral metachronous tears in the Spigelian fascia, which was successfully treated through surgical repair. A 20-year-old man with end-stage kidney disease due to Alport syndrome underwent PD. Eight months after induction of PD, he heard a rupture sound in the left inguinal region after coughing and developed genital edema. A computed tomography scan showed a tear in the left Spigelian fascia. Surgical repair was successful and there was no recurrence after PD was resumed. Seven months after surgery, he heard a rupture sound in the right inguinal region after coughing and developed genital edema. A computed tomography scan showed a tear in the right Spigelian fascia. Surgical repair was successful and there has been no recurrence since. It is important to recognize that the development of scrotal edema in a patient undergoing PD may be indicative of a tear in the Spigelian fascia., Competing Interests: AcknowledgementsNone. Author contributionsKW wrote the first draft of the manuscript. All authors reviewed and edited the manuscript and approved the final version of the manuscript. Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction and Importance: Spigelian hernias are rare, constituting about 1-2 % of all abdominal wall hernias. They present clinically significant challenges due to their potential for incarceration and strangulation. This case report highlights a unique presentation of a Spigelian hernia involving sigmoid colon strangulation, emphasizing the critical need for awareness and timely intervention., Case Presentation: A 60-year-old female with hypertension and diabetes presented with severe left abdominal pain, nausea, and vomiting. Examination revealed leukocytosis, neutrophilia, and signs of acute abdomen. CT imaging showed a complicated left lateral abdominal wall hernia containing the sigmoid colon. Surgical intervention included sigmoidectomy with colorectal anastomosis and hernia repair. Postoperative recovery was successful with subsequent elective ileostomy reversal., Clinical Discussion: The rarity of Spigelian hernias and their atypical presentations can complicate diagnosis and management. This case was particularly challenging due to the strangulation of the sigmoid colon within the hernial sac. Surgical management was necessary to address the incarcerated bowel segment and prevent further complications. This case underscores the utility of CT scans in diagnosing complex cases and guiding surgical strategy., Conclusion: Despite their rarity, Spigelian hernias carry significant risks of strangulation. Prompt diagnosis and treatment are essential to avoid severe complications. This case highlights the importance of including Spigelian hernia in the differential diagnosis for acute abdominal symptoms, especially when they are nonspecific., Competing Interests: Declaration of competing interest None of the authors have any conflicts of interest to declare., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

A 49-year-old woman with a complicated hernia presentation, including direct and indirect inguinal hernias, Spigelian hernias, and Pantaloon hernias, is presented in the case report. The diagnosis was verified by a comprehensive physical examination and imaging, which resulted in a Lichtenstein operation for repair. The surgical procedure for hernia comprised of painstaking dissection, reduction of the hernia sac, and implantation of a prosthetic mesh. The instance emphasizes the value of individualized treatment programs and draws attention to the intricate anatomical details of hernia surgery. Analyzing situations that are similar to one another highlights the necessity of customized strategies to improve patient outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Navandhar et al.)

Introduction: Spigelian hernia is a rare type of abdominal wall hernias which are often diagnosed when incarcerated. These hernias typically develop at the crossing point of the arcuate line and lateral portion of rectus abdominis muscle., Case Report: We present the case of a 44-year-old female patient admitted to our surgery unit for a painful lump in her right mesogastrium. Incarcerated atypical hernia in the right mesogastrium was suspected based on completed imaging assessments. Spigelian hernia was confirmed by preoperative findings. Interestingly, the patient applied interferon (multiple sclerosis therapy) at the site of the lump, which is why the diagnosis of lipodystrophy had been considered., Conclusion: In general, the diagnosis of Spigelian hernia is difficult. From the anatomical point of view the clinical finding is not always specific. The risk of incarceration is relatively high, and thus even clinically silent findings are indicated for surgery.

Background: Compared to other types of abdominal protrusions, Spigelian hernias are not very common. In prosthetic repair of abdominal protrusions, mesh fixation and defect overlap are an open issue, as they are a source of complications. A newly developed tentacle-shaped mesh has been used to ensure a fixation-free repair with a broader defect overlap in the repair of abdominal hernias. This study describes the long-term results of a fixation-free repair of Spigelian hernias carried out with a tentacle mesh., Methods: A proprietary mesh composed of a central body with integrated radiating arms was used for repairing Spigelian hernias in 54 patients. The implant was positioned in preperitoneal sublay, and the straps were delivered across the abdominal musculature with a needle passer, and then, after fascia closure, cut short in the subcutaneous layer., Results: The friction of the straps passing through the abdominal wall served to hold the mesh in place, guaranteeing a wide overlap over the defect without fixation. In a long-term follow-up of 6 to 84 months (mean 64 months), a very low rate of complications occurred, but no recurrence was reported., Conclusions: The tentacle strap system of the prosthesis allowed for an easy, fast and safe fixation-free placement granting a wide overlap, avoiding intraoperative complications. Greatly reduced pain and a negligible amount of postoperative complications characterized the postoperative outcome.

Introduction: Spigelian hernia is a rare entity, with higher improbability of acute appendicitis within it., Case Report: A 75-year-old female with a 30-year evolution hernia, abdominal pain, and fever of 1 week of onset, in whom was found an acute appendicitis within a Spigelian hernia., Discussion: Spigelian hernia comprises 0.12-2% of all abdominal hernias. Presurgical diagnosis is stablished only in 50% of cases, with an hernial ring less than 2 cm and hidden localization. There isn't statistics of this complication because of the lack of case reports., (Copyright: © 2023 Permanyer.)

Background: Spigelian hernias (SpH) belong to the group of eponymous abdominal wall hernias. Major reasons for diagnostic difficulties are its low incidence reaching maximum 2% of abdominal wall hernias, a specific anatomical localization with intact external oblique aponeurosis covering the hernia sac and non-constant clinical presentation., Methods: A literature review was completed to summarize current knowledge on surgical treatment options and results., Results: SpH presents a high incarceration risk and therefore should be operated upon even if the patient is asymptomatic. Both laparoscopic and open repair approaches are validated by current guidelines with lesser postoperative complications and shorter hospital stay in favour of minimally invasive surgery, regardless of the technique used. Overall recurrence rate is very low., Conclusion: All diagnosed SpH should be planned for elective operation to prevent strangulated hernia and, therefore emergency surgery. Both open and laparoscopic SpH treatment can be safely performed, depending on surgeon's experience. In most cases, a mesh repair is generally advised., (© 2021. The Author(s).)

Blunt abdominal trauma due to bicycle accident is a common occurrence in the pediatric population; however, traumatic abdominal wall hernia as the result of blunt trauma is a rare presentation. Abdominal wall injuries can be isolated or associated with multiple intra-abdominal pathologies. A high index of suspicion is essential for prompt intervention, especially when there is concurrent intra-abdominal pathology. We present a case of a traumatic spigelian hernia in a pediatric patient following a handlebar injury with the intraoperative discovery of a bucket-handle type mesenteric injury to the jejunum.

Introduction: Spigelian hernia is a rare differential diagnosis of abdominal pain. It affects mainly women above the fifth decade of life, more on the left side than on the right side, usually with comorbidities that lead to an increase in intra-abdominal pressure, described as risk factors for the outbreak of ventral hernias. The content of a ventral hernia might be an epiploic appendix and lead to appendagitis., Presentation of Case: This article presents the case of an 82-year-old female patient who presented epiploic appendagitis in a Spigelian hernia., Discussion: Spigelian hernia is a rare type of ventral hernia, especially in association with an epiploic appendagitis. A literature search of this rare entity yielded three publications presenting epiploic appendagitis in a Spigelian hernia. The initial approach after the diagnosis should be adequate analgesia associated with surgical correction of the hernia. There is no gold standard treatment for the repair. European and American societies suggest that if there is no palpable nodule, laparoscopic repair is preferable, always using a mesh., Conclusion: Epiploic appendagitis in a Spigelian hernia is a rare condition whose diagnosis is a big challenge. However, the correct diagnosis can lead to a shorter hospital stay, with less cost and avoid the use of unnecessary medications., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Spigelian hernia is a rare lateral ventral hernia traditionally repaired through open incision with extensive dissection. Three laparoscopic techniques have been reported in the literature: intraperitoneal onlay mesh (IPOM), transabdominal preperitoneal (TAPP), and total extraperitoneal (TEP). TEP is less popular than the other approaches. We evaluated TEP's safety and effectiveness and compared different laparoscopic techniques., Methods: All patients with Spigelian hernia who had undergone extended TEP (eTEP) repair with mesh in our center from January 2007 to February 2020 were studied. A three-port technique with a preperitoneal space created by telescope at the midline was adopted. A systematic review on laparoscopic mesh repair was performed by searching for "Spigelian hernia" and "laparoscopic" from 1999 to 2019 in the MEDLINE database., Results: Seven patients underwent eTEP repair for Spigelian hernia. Five presented with abdominal mass and underwent preoperative imaging. Two were diagnosed incidentally during TEP for inguinal hernia. The mean operative duration was 65 minutes (range, 40-93 minutes). There were no open conversions or intraoperative complications. The mean length of hospital stay was 1.4 days (range, 1-3 days). The mean follow-up period was 44.3 months. One patient developed seroma. There was no recurrence or chronic pain. We identified 197 laparoscopic mesh repairs reported in 41 articles. IPOM (n = 91) was the most popular approach, followed by TAPP (n = 70) and TEP (n = 36). Laparoscopic mesh repair of Spigelian hernia is safe and offers excellent outcomes., Conclusion: We found the eTEP approach safe and effective for Spigelian hernia repair. IPOM, TAPP, and TEP are comparable., (© 2020 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.)

Objective: Spigelian hernia is an uncommon congenital or acquired defect in the transversus abdominis aponeurosis with non-specific symptoms posing a diagnostic challenge. There is a paucity of radiology literature on imaging findings of Spigelian hernia. The objective of this study is to explore the role of MDCT in evaluating Spigelian hernia along with clinical and surgical implications., Materials and Methods: In this IRB approved, HIPAA compliant retrospective observational analysis MDCT imaging findings of 43 Spigelian hernias were evaluated by two fellowship-trained radiologists. Imaging features evaluated were: presence of Spigelian hernia, laterality, relation to "hernia belt" (between 0 and 6 cm cranial to an imaginary axial line between both anterior superior iliac spines), the hernia neck and sac sizes, hernia content, and other coexistent hernias (umbilical, incisional, inguinal). Patient's demographics (age, gender, BMI, conditions with increased intra-abdominal pressure) were also recorded for any correlation., Results: 60% (26/43) of Spigelian hernias were located below the hernia belt while 33% (14/43) within the hernia belt and 7% (3/43) above the hernia belt. The most common subtype of Spigelian hernia encountered was interparietal (84%). The mean hernia neck diameter was 3.4 cm, mean hernia sac volume was 329 cc. Hernia content included: fat (43/43) bowel (23/43), fluid (3/43). 3 patients had no clinical history provided, the remaining 37 patients' clinical presentation was asymptomatic in 73% (27/37), acute abdominal pain in 5% (2/37) and chronic abdominal pain in 22% (8/37). None of the hernia were incarcerated and none of the patients underwent emergent surgery. No significant correlation was noted between Spigelian hernia and causes of increased intra-abdominal pressure. 90% of our patients had other abdominal hernias. 30.9 was the mean BMI (20.8-69.1)., Conclusion: Most of the Spigelian hernia occurred below the traditionally described hernia belt and the majority are of interparietal subtype that can be best diagnosed with MDCT in contrast to physical examination., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Introduction and Importance: The usefulness of laparoscopic surgery in the treatment of Spigelian hernias and the appropriate insufflation pressure remains unclear., Case Presentation: Case 1 involved an 81-year-old woman presented with a right abdominal protrusion. CT scan demonstrated a defect in the abdominal wall at the lateral edge of the right rectus abdominis muscle. We diagnosed as Spigelian hernia and performed laparoscopic hernia repair. The insufflation pressure was set at 10 cm H 2 O, and the IPOM method was selected as the repair method. Case 2 involved a 74-year-old male presented with a right abdominal painful bulging. Strangulation was released and CT scan demonstrated a defect in the abdominal wall at the lateral edge of the right rectus abdominis muscle. We diagnosed as Spigelian hernia and performed laparoscopic hernia repair. The insufflation pressure was set at 10 cmH 2 O, and the repair was performed by the hybrid method., Clinical Discussion: In both cases, the positions of the hernia portals marked preoperatively based on the tender areas and confirmed laparoscopically were not accurate. Although Spigelian hernia is a rare disease and various laparoscopic techniques have been reported in recent years, laparoscopic surgery is very useful to obtain an accurate diagnosis and to observe the abdominal wall from inside the abdominal cavity under insufflation, and it is better to decide the repair method according to the situation of each case and institution., Conclusion: Laparoscopic surgery is important for accurate diagnosis in surgery of Spiegel's hernia, and insufflation pressure of 10 cmH2O was sufficient., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Spigelian hernias (SH) are rare intraparietal abdominal wall hernias occurring just medial to the semilunar line. Several small series have reported on laparoscopic SH repair and both totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) approaches have been described. However, there are limited outcome data including both of these techniques. We present the largest series to date of laparoscopic SH repair comparing both popular approaches., Methods: Consecutive patients (n = 77) undergoing laparoscopic SH repair from 2009 to 2019 were identified from a prospectively managed quality database. All procedures were performed at a single institution. Patients were divided based on laparoscopic approach used, TEP group (n = 37) and TAPP group (n = 40). Comparison of patient demographics, surgical characteristics, and post-operative complications between TAPP and TEP groups was made using the Wilcoxon rank-sum and Fisher's exact tests., Results: Individuals undergoing TAPP had higher mean BMI (29.3 ± 5.4 vs. 26.3 ± 5.6 kg/m 2 ; p = 0.019) and were more likely to have had prior abdominal surgery (65% vs 24.3%, (p < 0.001). Mean procedure length was 77 ± 45 min for TAPP repairs and 48 ± 21 for TEP repairs (p = 0.001). TAPP repairs had a significantly longer median LOS than TEP (25 vs. 7 h; p < 0.001). Days of narcotic use were significantly shorter after TEP repair than for TAPP (0 vs. 3; p = 0.007) and return to ADL was significantly shorter after TEP repair than for TAPP (5 vs. 7 days; p = 0.016. There were no significant differences in readmission, reoperations, SSI, or recurrence between the two groups., Conclusion: Our large series revealed that both preperitoneal laparoscopic approaches, TEP, and TAPP, for SH repair are equally safe, effective, and can be performed on an outpatient basis. Therefore, we suggest that the approach used for repair should be based on surgeon experience, preference, and individual patient factors.

Spigelian hernia is very rare in the paediatric age group. We present the case of an 11-month-old male child who presented with left Spigelian hernia with the left undescended testis in its sac. Hernia repair with orchidopexy was done using total laparoscopic approach. It is the first reported case of total laparoscopic repair of Spigelian hernia with undescended testis in the paediatric age group., Competing Interests: None

We describe the original technique used for the treatment of a patient who presented with pain and bulging in the abdomen, who was diagnosed with Spigelian hernia (SH) using ultrasound. In this case, the hernia occurred in the anterolateral abdominal wall with herniation of the distal ileum and mesentery, in addition to a large right inguinal hernia. A mini-laparoscopic approach was proposed; due to Child-A hepatic cirrhosis, it was done by a hybrid technique, using a harmonic scalpel. The primary closure of the hernia defects was performed, followed by the placement of a polypropylene mesh in the preperitoneal space. The mesh was fixed. In this case, the inguinal hernia was homolateral to the SH. Following the surgery, the patient had no further complications, being discharged the day after the procedure., Competing Interests: None

Spigelian hernia is one of the most uncommon hernia of the abdominal wall. Authors present 53 years old women with left sided spigelian hernia containing: caecum with appendix and ileum, which was an uncommon content of hernial sac. Past medical history of urinary bladder operation suggested postoperative hernia. However, the correct diagnosis was made during the operation. Hernioplasty was made with mesh onlay method. The postoperative course was unevenful.

Spigelian hernia is a rare type of anterior abdominal wall hernia. While it is itself very rare, seeing urinary bladder in this hernia is even rarer. Here, in this case, we specifically illustrate a rare case of Spigelian hernia including the urinary bladder, diagnosed with computerized tomography., (Copyright Journal of Radiology Case Reports.)

Introduction: Spigelian Hernia is an uncommon pathology of abdominal wall (0.12-2.4%), usually small sized and with vague symptoms. It rarely presents as Small Bowel Obstruction or reaches dimensions that becomes clinically remarkable., Presentation of Case: 84-year-old woman entered our Surgical Department for Small Bowel Obstruction due to a giant (8 × 7 cm) abdominal wall hernia, which was intraoperatively identified as Spigelian Hernia. We performed a minilaparotomy with reduction of viable small bowel and preperitoneal positioning of polypropilene mesh. Postoperative course was uneventfull., Discussion: Due to its small dimensions and infrequence, the diagnosis could be challenging even if the patient undergoes a CT scan. The presentation with clear signs of small bowel obstruction associated with a large abdominal hernia is rare and suggests a urgent surgical approach with mesh repair to avoid recurrences., Conclusion: Even if rarely symptomatic, the Spigelian Hernia is an entity to consider in the differential diagnosis of small bowel obstruction in a virgin abdomen. Preoperative diagnosis, when available, is mandatory to guide a correct surgical approach., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Spigelian hernia (SH) is a rare ventral interstitial hernia occurring through a defect in the transversus abdominis aponeurosis (Spigelian fascia). Spigelian fascia is found between the lateral border of the rectus abdominis muscle and the semilunar line, which extends from the costal cartilage to the pubic tubercle. In other words, Spigelian line is where the transversus abdominis muscle ends in an aponeurosis characterized by a congenital or acquired defect in the Spigelian aponeurosis. Pediatric cases of SH are either congenital or acquired due to trauma, previous surgery or increased intra-abdominal pressure. SH in combination with ipsilateral cryptorchidism may constitute a new syndrome, as such cases are extremely rare in the literature is new syndrome is characterized by the following congenital, ipsilateral disturbances: SH, absence of inguinal canal and gubernaculum and the homolateral testis found within the Spigelian hernia sac (a hernia sac containing undescended testis). The aim of this study is to emphasize some typical findings of this specific entity, and, hence, the necessity for a thorough investigation of the origin of the SH.

Background: Spigelian hernia is a ventral hernia in the anterior abdominal wall extremely rare in children., Clinic Case: A 13 years old patient is presented with a Spigelian hernia. A surgical repair was successfully performed through a laparoscopic transperitoneal approach without prosthetic reinforcement. A review of 35 pediatric patients published on PubMed between 2000 and 2015 was performed and different therapeutic approaches in pediatric patients were analyzed. Only one patient, and the case reported on this paper, was entirely treated with a laparoscopic approach., Conclusions: Spigelian hernias in childhood can be securely closured with laparoscopic transperitoneal approach., (Copyright: © 2019 Permanyer.)

Background: Spigelian hernia (SH) is rare and constitutes less than 2% of all hernias. It is reported that more than 90% of SHs lie in the "Spigelian belt", but SH in the upper abdominal wall is extremely uncommon. Here, we report a case of SH in the right upper quadrant of abdomen., Case Presentation: A 38-year-old female was admitted to hospital with complaints of abdominal pain and right upper quadrant mass for 10 days. Contrast-enhanced computed tomography (CECT) of abdomen revealed the dilated small intestine between the swelling ventral muscles in the right upper abdominal wall which suggested a ventral hernia. The surgeons considered it was a spontaneous hernia because there was no history of surgery or trauma in the upper abdomen. About two hours later, the patient underwent emergency surgery. According to laparotomy, a diagnosis of SH with ileum herniation in the right upper abdominal wall was confirmed. The necrotic ileum segment was resected. Meanwhile the abdominal wall defect was repaired by suturing the internal oblique and transverse muscles to the rectus sheath. The patient had a favorable outcome for 1 year without recurrence., Conclusion: A mass and pain in the upper abdominal wall may suggest an atypical SH. SH occurring in the upper abdominal wall is a rare condition with possibility of dire outcome if not managed early.