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Ventral hernia is a broad term that describes all anterolateral abdominal wall defects. These defects are either primary or incisional. It is a common pathology encountered frequently by general surgeons globally. This article describes the pathogenesis, risk factors and the current management, as well as highlighting practice points. [ABSTRACT FROM AUTHOR]

Spigelian hernias represent only 0.1–0.2 % of all abdominal wall hernias and are infrequently encountered in pediatric patients. Limited literature surrounding pediatric Spigelian hernias exists, and there is no uniform or optimal surgical repair technique. A term female with unremarkable prenatal history presented a left-sided Spigelian hernia at birth that contained loops of bowel, by physical examination and ultrasound. The hernia was easily reducible, so she was discharged with a plan for an elective repair at a later point. At 8 months of age, she underwent an abdominal wall ultrasound that showed a defect of 6 cm in length. She underwent elective repair at 9 months of age due to parental preference in the setting of an enlarging defect size. The hernia repair was done through a combination of laparoscopic and open techniques. The laparoscopy part, which consisted in one port placed in the umbilicus for a camera, enabled visualization of the suspected hernia site, confirm the proper approximation of the lateral and medial borders of the hernia, and helped avoid any intra-abdominal injuries during the repair. The repair itself was completed in an open manner with interrupted sutures in a top to bottom approach, in a transverse orientation. The patient recovered well from the operation. At 1 year of follow up she has shown no signs of recurrence. Congenital pediatric Spigelian hernias can be successfully repaired using a combination of laparoscopy and open approach. The addition of a laparoscopy allows proper visualization of the intra-abdominal side of the repair. [ABSTRACT FROM AUTHOR]

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. 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. 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. 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. • Describes a unique instance of Spigelian hernia involving sigmoid colon strangulation in a 60-year-old female, leading to severe symptoms. • Emphasizes the importance of CT in diagnosis and details the complex surgical intervention required for treatment. • Notes the successful recovery following surgery, highlighting the effective management of this complicated case. [ABSTRACT FROM AUTHOR]

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. 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. 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). 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. • There is a paucity of radiology literature on imaging findings of Spigelian hernia • Only 50% of Spigelian hernias are diagnosed preoperatively by physical examination and have nonspecific clinical symptoms, with abdominal pain varying in type, severity, and location depending on the contents of a hernia and thus pose a diagnostic challenge clinically. • There are two major types of Spigelian hernia- interparietal and subcutaneous. The interparietal type does not penetrate the external oblique aponeurosis, and the subcutaneous type penetrates it. • The majority of Spigelian hernias occur in the hernia belt according to the surgical literature. Our findings show only 33% of the Spigelian hernias were located in the hernia belt. There was no significant statistical correlation between a Spigelian hernia and a list of causes that increase intra-abdominal pressure. • We found no statistically significant correlation between patient age, gender, body mass index (BMI) at the time of imaging, or history of acute or chronic hernia symptoms, and the presence of a Spigelian hernia. [ABSTRACT FROM AUTHOR]

'Abdominal wall defects' is a collective term used to describe two distinct pathologies: primary ventral hernias and incisional hernias. This article describes the pathogenesis, risk factors and the management of each. [ABSTRACT FROM AUTHOR]

• Hernia repair is associated with higher morbidity in chronic liver disease. • Chronic abdominal pain following transplantation is a diagnostic challenge. • Incidental appendectomy in the immunosuppressed carries additional risk. • Mesh repair can be safely performed following liver transplantation. • Uncommon ventral hernias can be the source of chronic abdominal pain following liver transplantation. Abdominal ventral hernias are common in chronic liver disease due to increased abdominal pressure and sarcopenia. Following liver transplantation, diagnosis of chronic abdominal pain is challenging because it may relate to immunosuppression, scaring or opportunistic infections. A 62 years-old male presented with chronic abdominal pain one year following liver transplantation due to hepatocellular carcinoma. After work-up he was diagnosed with a Spigelian hernia containing the appendix. We did hernia repair with mesh but appendectomy was not performed since it showed no signs of inflammation. On follow-up the patient had complete resolution of the pain. This is the first case of spigelian hernia containing the appendix following liver transplantation. Mesh repair can be safely performed in this setting but incidental appendectomy is controversial due to higher morbidity and mortality. In this case report we discuss the relationship between liver transplantation, abdominal hernias and the pitfalls of incidental appendectomy. Uncommon ventral hernias are a possible cause for chronic abdominal pain after surgery and should be investigated with imaging studies. Mesh repair is safe but incidental appendectomy in the immunosuppressed is not encouraged due to increased morbidity. [ABSTRACT FROM AUTHOR]

• Spigelian Hernia is a rare abdominal wall hernia. • Urgent presentation with small bowel obstruction is uncommon. • Laparoscopy could be an option in elective surgery but in emergent setting laparotomy is required. • Mesh repair is mandatory to avoid recurrence. 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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

Introduction A Spigelian hernia is a rare type of abdominal wall hernia occurring in an area of congenital or acquired defect. These hernias occur in an area called the Spigelian zone and are interparietal making for a difficult diagnosis on clinical exam. Presentation of Case A 74-year-old female presenting with bilateral inguinal herniae and a left sided Spigelian hernia. The repair was done laparoscopically with an intra-corporeal suture closing the Spigelian hernia neck. Her recovery was uneventful. Discussion The aetiology of Spigelian herniae remains nebulous. Due to their rarity and evasive nature on clinical exam, ultrasound imaging has become the first line in diagnosis. Open herniorrhaphy is still the most common technique, but laparoscopic repair is becoming more commonplace in the surgical armamentarium. Conclusion Spigelian herniae are rare with non specific symptoms. We present the first case report of a laparoscopic repair of bilateral inguinal herniae and a left sided Spigelian hernia with intra-corporeal suturing of the Spigelian hernia neck. [ABSTRACT FROM AUTHOR]

The first clinical presentation of a hernia developing along the Spigelian line had been reported by Klinkosch. The Belgian anatomist Adriaan van der Spieghel (Adrianus Spigelius) was the first to describe the semilunar line now known as the linea Spigeli in 1645. Spigelian hernias are rare and account for 1 % to 2 % of all abdominal wall hernias. Most of these hernia occurs in the lower abdomen where posterior sheath is deficient. The hernia ring is well defined defect in the transverse aponeurosis. A 60 year old female, presented with a palpable lump at the right lower quadrant of the abdomen since 7 month before her presentation. For the first time the swelling is small and painless then gradually increase in size and associated with dull aching pain. The swelling was reducible with a defect of size 4 × 4 cm palpable in right iliac fossa. There was a positive cough impulse. The swelling was non tender. Other hernial orifices were normal. No inguinal lymphadenopathy noted. Abdominal ultrasonography done revealed a defect in abdominal wall in right iliac fossa with reducible bowel content. Depending on basis of clinical and investigations, a diagnosis of Spigelian hernia was made. After preparation for surgery, exploration done. The defect measuring 4 cm in length was identified and anatomical repair was done with nylon- 0, by suturing medial border of internal oblique and transverse abdominus muscle to the lateral border of rectum abdominal wall followed by hernioplasty by mesh. Spigelian hernias are rare multifactorial disorder leading to defect in the transversus abdominis muscle in anterior abdominal wall. Spigelian hernias carry a significant risk of incarceration and strangulation of sac content. The management of spigelian hernias is almost always surgical which can be done in a traditional open fashion or laparoscopically. • The first clinical presentation of a hernia developing along the Spigelian line had been reported by Klinkosch. • Spigelian hernias are rare and account for 1 % to 2 % of all abdominal wall hernias. • Most of these hernias occur in the lower abdomen where posterior sheath is deficient. • Spigelian hernias carry a significant risk of incarceration and strangulation of sac content. • The management of spigelian hernias is almost always surgical which can be done in a traditional open fashion or laparoscopically. [ABSTRACT FROM AUTHOR]

Introduction Spigelian hernias are a rare type of hernia which protrude through the abdominal wall at the semilunar line. They are especially difficult to diagnose due to their location and non-specific symptoms and are often overlooked because of their positioning between muscular layers. Patients may present with localized pain which can aid the diagnosis. CT and ultrasound are also helpful. Presentation of case: We present the case of a 75-year-old female patient who presented to Hialeah Hospital with a one-year history of abdominal pain localized to the left lower quadrant. Discussion A Spigelian hernia containing omentum, was found during a diagnostic laparoscopy. The hernia was reduced, and the abdominal defect was repaired via primary repair, reinforced by mesh. The patient recovered uneventfully. Conclusion Nonspecific physical exam findings and inconclusive imaging studies represented a diagnostic challenge. Here we discuss a case of a Spigelian hernia discovered through diagnostic laparoscopy. [ABSTRACT FROM AUTHOR]

Spigelian hernia is an uncommon hernia presenting as a protrusion of abdominal contents through the spigelian fascia, lateral to the rectus abdominis. In some rare cases, Spigelian hernia can occur alongside cryptorchidism, which forms a recognized syndrome found in male infants with Spigelian hernia. This is a relatively unreported syndrome with very limited literature available regarding it, none of which is reported in Pakistan in adults. We report a case of a 65-year-old male with right sided obstructed spigelian hernia along with the rare finding of testis in the hernial sac. The patient was successfully managed by transperitoneal primary repair (herniotomy) with orchiectomy. The patient recovered uneventfully and was discharged 5 days after the surgery. The exact pathophysiology of this syndrome remains unclear. Three theories have been proposed to explain this syndrome, including the primary defect being Spigelian hernia leading to undescended testes (Al-Salem), testicular maldescent preceding the formation of the hernia (Raveenthiran), or the absence of the inguinal canal leading to the development of a rescue canal due to the undescended testes (Rushfeldt et al.). In this case, the absence of gubernaculum was confirmed suggesting the findings to be consistent with Rushfeldt's theory. The surgical team proceeded with hernial repair and orchiectomy. In conclusion, Spigelian-Cryptorchidism syndrome is a rare syndrome in adult male, with an unclear pathophysiology. Management of this condition involves repair of the hernia along with either orchiopexy or orchiectomy, depending upon the risk factors involved. • We reporta patient who presented with a right sided obstructed spigelian hernia along with undescended testes, forming the rare 'Spigelian-Cryptorchidism Syndrome' • Patient was successfully managed by transperitoneal primary repair along with orchiectomy. • This report discusses the management and discusses this rare syndrome in detail. • Very limited literature is available on this syndrome, with none previously reported in Pakistan. Hence, the authors felt a need to compile this case report. [ABSTRACT FROM AUTHOR]

Spigelian hernia is a rare abdominal wall hernia, representing 0.1 to 2 % of all ventral hernias. Clinically, the signs and symptoms are nonspecific and unclear. Here, we present a 69-year-old female patient, with abdominal bulging in both iliac fossae. Imaging exams suggested Spigelian hernia and right inguinal hernia. The treatment was surgical, with placement of polypropylene meshes and the patient had an uneventful postoperative evolution. The characteristics of this case corroborate the current literature, which points to a greater involvement of adults aged between 40 and 70 years. The treatment of choice is surgery, which can be open or videolaparoscopic, with placement of a mesh or primary suture. The clinical presentation of Spigelian hernia is not characteristic and its diagnosis should be suspected during the investigation of an abdominal mass. • Spigelian hernia occurs in less than 2 % of all abdominal hernias. • It mainly affects women aged between 40 and 70 years. • It usually presents with a palpable abdominal mass, chronic abdominal pain, or both. • Open or videolaparoscopic surgery should be performed to treat this condition. [ABSTRACT FROM AUTHOR]

Spigelian hernias are rare abdominal wall defects that occur at the semilunar line lateral to the rectus abdominis muscle. They are located between the muscular layers of the abdominal wall and can be easily overlooked because of abdominal obesity. They are difficult to diagnose because of their location and vague symptoms. The diagnosis has been considerably aided by the introduction of ultrasonography and Computed Tomography. We report a case of 60 years old male who presented with swelling and vague abdominal discomfort in the right lower abdomen and was diagnosed with the help of CT scan in prone position. The patient underwent transabdominal preperitoneal repair laparoscopically. His recovery was uneventful. Spigelian hernia constitutes about 0.12 to 0.2 % of all abdominal hernias. It commonly occurs in semilunaris line, well-defined defect in the Spigelian aponeurosis at the "Spigelian hernia" belt. Ultrasound scanning is recommended as first line imaging investigation in suspected case. Prompt surgical repair is recommended for spigelian hernia to prevent subsequent strangulation. Since spigelian hernia is a rare entity a high index of suspicion is required for accurate diagnosis. Once diagnosis is made, operative management is required to prevent incarceration. • Spigelian hernia is rare abdominal hernia occurs the anterior abdominal wall adjacent to the semilunar line. • Computerized Tomography (CT) scan of the abdomen with contrast has become the best imaging method in confirming the diagnosis OF Spigelian hernia • Spigelian hernias require operative repair due to risk of strangulation. [ABSTRACT FROM AUTHOR]

Introduction Spigelian hernia (SH) is a rare ventral hernia occurring near the lateral border of the rectus muscle. The treatment remains controversial and depends on institutional expertise. Although laparoscopic surgery is a good adaptation for the repair of ventral hernias, only a few cases have been reported in the literature. Here, we report a case of totally extra-peritoneal (TEP) repair for bilateral SHs. Presentation of case A 74-year-old Japanese man presented with asymptomatic bulges in the right lower abdominal quadrant. On physical examination, the bulges were located to the right of the lateral border of the abdominal rectus muscle and the right inguinal region in an upright position. We diagnosed right SH and coincident homonymous ipsilateral inguinal hernia (IH) by abdominal computed tomography and planned a curative operation by laparoscopy. By first laparoscopic exploration, we found an asymptomatic SH to the left of the lateral border of the abdominal rectus muscle and performed TEP repair for all hernias. The second laparoscopic exploration after fixing the mesh in place revealed that the orifice of the right SH was scarred and stiffened by repeated prolapse. We finally eliminated the sac by ligation because of a fear causing of reduction en masse of the SH. Discussion and conclusion The use of laparoscopy simplified the diagnosis and facilitates the subsequent repair of the hernia. TEP approach is the ideal treatment for the simultaneous laparoscopic repair of SH and IH. [ABSTRACT FROM AUTHOR]

Abstract Purpose Pediatric spigelian hernias are very rare. They are often missed or misdiagnosed. A series of cases with spigelian hernia, presented to a tertiary care center are presented here with emphasis on different anatomy of spigelian hernias with cryptorchidism and those without associated cryptorchidism. Materials and Methods Over a period of seven years, nine cases of spigelian hernia presented to our tertiary care center. Male:female ratio was 3:1.There was a preponderance of right sided hernias. Three patients had associated cryptorchidism. One patient had associated lumbar hernia. All three patients with cryptorchidism had low spigelian hernia while others had classical spigelian hernia. Conclusion There is a likelihood of anatomical variation in SH associated with UDT and those without UDT. Understanding this anatomy may help in correct scrotal placement of testis. Type of Study Prospective Observational. Level of Evidence 4. [ABSTRACT FROM AUTHOR]

Background/Purpose The purpose of this study is to present a summary of paediatric Spigelian hernia (SH) reported to date, and discuss possible aetiology of SH associated with ipsilateral ectopic testis (SH-ET). Methods Search of PubMed, Medline, Embase, and CINAHL was performed using keywords “Spigelian hernia”. The following were extracted from articles describing paediatric SH: demographics, site and contents of SH, comorbidities, proposed aetiology, presence of ipsilateral inguinal canal (IC) and gubernaculum (G). Results There were 78 patients with 88 hernias (69 male, 19 female), including 55 male (19 left, 22 right, 7 bilateral) and 16 female (5 left, 5 right, 3 bilateral) nontraumatic SHs. In nontraumatic male SH, 29 hernias contained testis (10 left, 11 right, 4 bilateral), 15 did not, 10 had no data. Of 29 SH-EH, 15 were lacking IC and G, 3 were missing IC (no G data) and 2 had absent G (no IC data). The combination of SH and cryptorchidism is increasingly recognised as a distinct syndrome. However, there is controversy as to the pathogenic mechanism of this association. We hypothesise SH-ET develops because the G, and therefore IC and line of descent, become cranially ‘mislocated’ along the mammary line, which overlies the Spigelian fascia. Conclusion SH is rare in children. SH-ET may result by testicular descent to an ectopic site along the embryological mammary line. [ABSTRACT FROM AUTHOR]

Introduction An interparietal inguinal hernia is a rare form of hernia. In this type of hernia, the sac passes between the layers of the abdominal wall of the inguinal canal area. Although its treatment is very simple but pre-operative diagnosis is really a challenging issue. Presentation of case A 62 years old male patient presented with complaint of a large swelling over right lower abdomen with absence of right testes since birth. The lump was measured 26 × 22 cm in size. Ultrasonography (USG) and Contrast enhanced computed Tomography (CECT) failed to diagnose as interparietal inguinal hernia which was proved intra-operatively. Few cases have been reported in the medical literature like this. Discussion Exploration revealed the large abdominal lump presenting as an interparietal inguinal hernia. Hernia sac was lying in between external & internal oblique muscles. The right testis was intraabdominal & atrophied. The external inguinal ring was almost completely obstructed. Conclusion An interparietal hernia with undescended testis is a very rare presentation. Even with USG & CT scan diagnosis is very challenging and final diagnosis can be made only intraoperatively. [ABSTRACT FROM AUTHOR]

Spigelian hernia is an uncommon surgical condition in children and accounts for only 1% of all abdominal hernias. Its traumatic origin has been described sporadically in the literature. We report a case of a 9-year-old boy, brought to the emergency department 2 hours after abdominal trauma caused by a bicycle's handlebar grip at the lower abdomen, complaining of abdominal pain. Apart from edema, bruising and tenderness of the right of lower abdomen, physical examination showed a 1.5 * 2 cm reducible swelling lateral to the rectus muscle and a 1-cm facial defect of the anterior abdominal wall at the same site. Ultrasonography concluded to diastasis between the rectus abdominis muscle and the broad abdominal muscles with evidence of a hernia sac. The diagnosis of traumatic Spigelian hernia was retained and the patient was operated on. He had primary repair of the defect in layers using interrupted sutures. He was discharged in the same day and the aftermath of surgery was uneventful. In conclusion, traumatic Spigelian hernias are rare entities in children which diagnosis should be considered following blunt abdominal trauma. We recommend careful abdominal examination after trauma to highlight swelling and/or aponeurotic defect. • Spigelian hernia is an uncommon surgical condition in children and accounts for only 1% of all abdominal hernias. • Diagnosis of Spigelian hernias is difficult especially after blunt abdominal trauma. • Careful abdominal examination is recommended to highlight swelling and/or aponeurotic defect. • The treatment is only surgical and should be performed without delay because of incarceration and strangulation risks. [ABSTRACT FROM AUTHOR]

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. This article presents the case of an 82-year-old female patient who presented epiploic appendagitis in a Spigelian hernia. 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. 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. • An epiploic appendix can be the content of a Spigelian hernia. • Imaging tests such as ultrasonography and computed tomography are essential. • The surgical correction of the hernia can be open or laparoscopic, using a mesh. [ABSTRACT FROM AUTHOR]

Introduction Abdominal wall hernias through the arcuate line termed Spigelian hernias are uncommon. These hernias presenting as a Richter-type, with strangulation of part of the circumference of the bowel wall is very rare. Presentation of case We report a 27-year-old male patient who presented with a Richter-type Spigelian hernia. Literature review A MEDLINE literature search of this rare entity yielded six publications presenting Richter-type Spigelian hernias. All of these articles and accompanying references were thoroughly reviewed. There was no gender or anatomical side predominance among the patients. All except our patient presented here were elderly. Pain was the most common symptom and was present in all patients. All patients underwent surgical repair and none reported recurrence of their hernia afterwards. Discussion and conclusion Richter-type Spigelian hernia is rare and has been reported infrequently in the existing literature. Clinical diagnosis is challenging and CT scan is the diagnostic study of choice. Surgical repair is the definitive treatment and involves primary or mesh repair of the defect as appropriate. Necrotic bowel should be resected and we recommend biologic mesh repair in these cases if the defect is large. [ABSTRACT FROM AUTHOR]

The usefulness of laparoscopic surgery in the treatment of Spigelian hernias and the appropriate insufflation pressure remains unclear. 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. 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. Laparoscopic surgery is important for accurate diagnosis in surgery of Spiegel's hernia, and insufflation pressure of 10 cmH2O was sufficient. • Laparoscopic surgery, which allows direct visualization under insufflation and accurate identification of the defect location, is necessary for optimal treatment of Spigelian hernias. • Although there have been few reports on the appropriate insufflation pressure, in this study, 10 cm H 2 O was sufficient for diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Abstract: INTRODUCTION: Spigelian hernias are a rare type of hernia through the Spigelian aponeurosis. Spigelian hernias are very uncommon and constitute only 0.12% of all abdominal wall hernias. These hernias are located in the aponeurosis of the internal oblique muscle and transverse abdominal muscle. PRESENTATION OF CASE: A 30-year-old woman at 28 weeks’ gestation was admitted to the obstetrics department due to pain and swelling in the anterior abdominal right region. On inspection, we suspected either a lipoma, a spontaneous hematoma, a tumor of the abdominal wall, or a Spigelian hernia. A Doppler USG and abdominal and pelvic Magnetic Resonance Imaging revealed necrobiotic fibroma of the uterus in Spigelian hernia. The patient was started on dual analgesic and corticotherapy. Overall, the patient improved one week after the acute episode and had no further pain during her gynecologic follow-up. DISCUSSION: We have reported a first case of Spigelian hernia that was complicated by uterine fibroid. The clinical presentation varies, depending on the contents of the hernial sac and the degree of herniation. MRI is the preferred method for accurately identifying masses of the abdominal wall. Our treatment options were based on the extent of the acute-phase reaction and the venous thrombosis. CONCLUSION: It is important to differentiate this rare Spigelian hernia from other hernias as the treatment for this hernia is medical rather than surgical. Before the final choice of treatment is made, digestive surgeons should bear this rare hernia in mind. [Copyright &y& Elsevier]

Introduction: Spigelian hernia is an uncommon abdominal wall hernia occurring through the linea semilunaris located near the lateral border of the rectus abdominis muscle. Case report: We report an extremely rare case of incarcerated Meckel's diverticulum within a Spigelian hernia diagnosed by multidetector computed tomography. [ABSTRACT FROM AUTHOR]

Abstract: Spigelian hernia is a rare hernia of the ventral abdominal wall accounting for 1–2% of all hernias. Incarceration of a Spigelian hernia has been reported in 17–24% of the cases. We herein describe an extremely rare case of a colonic obstruction secondary to an incarcerated Spigelian hernia in a severely obese patient. Physical examination was inconclusive and diagnosis was established by computed tomography scans. The patient underwent an open intraperitoneal mesh repair. A high level of suspicion and awareness is required as clinical findings of a Spigelian hernia are often nonspecific especially in obese patients. Computed tomography scan provides detailed information for the surgical planning. Open mesh repair is safe in the emergent surgical intervention of a complicated Spigelian hernia in severely obese patients. [ABSTRACT FROM AUTHOR]

Abstract: Spigelian hernia is extremely rare, with an incidence of 1% to 2% of all abdominal hernias. Herein we report the case of a woman with a spigelian hernia occurring within 48 hours after laparoscopic salpingo-oophorectomy. The patient had abdominal pain, nausea, and abdominal mass. An abdominal series revealed multiple dilatations of the small bowel, compatible with a small bowel obstruction, and computed tomography demonstrated a right-sided abdominal hernia with small bowel obstruction. The diagnosis of spigelian hernia was made during a second surgery. The bowel was reduced and the fascial defect repaired. The postoperative recovery was uneventful. It would seem that pneumoperitoneum during laparoscopic surgery and the trauma of trocar insertion can trigger development of a spigelian hernia. [Copyright &y& Elsevier]

Abstract: INTRODUCTION: Spigelian hernias are rare hernias of the anterior abdominal wall named after Adrian van den Spiegel, the anatomist who first described them in the 16th century. They represent around 2% of all hernias. PRESENTATION OF CASE: We present an 83-year-old female with one week history of a painful right iliac fossa swelling, her examination revealed a tender lump with no cough impulse and non-reducible and her computed tomography (CT) scan showed a mass anterior to ileocaecal valve suggestive of a caecal volvulus. Intra-operative the finding was a Spigelian hernia containing an appendicular abscess and an appendicolith. DISCUSSION: The diagnosis of Spigelian hernias represents a challenge for the surgeons principally due to their rarity but also due to their anatomy and the variety of their contents. Searching the literature we found many different intra-abdominal structures presenting within a Spigelian hernia but we did not encounter a case similar to this. CONCLUSION: Clinicians need to be aware of these hernias when dealing with lower abdominal swellings and have a high index of suspicion even in the presence of negative clinical and CT findings. [Copyright &y& Elsevier]

Abstract: We encountered a patient with a swelling in the left lateral infraumbilical region and a left undescended testis. The appearance of the swelling was suggestive of a spigelian hernia. At operation, the swelling was actually an abdominal ectopic testis with associated inguinal hernia. This unusual finding led us to report this occurrence and present a brief review of the relevant literature. [Copyright &y& Elsevier]

Abstract: A 78-year-old healthy woman with no previous surgeries or history of trauma presented with a painful abdominal mass for 1 day. The computed tomography (CT) scan of the abdomen demonstrated a partial herniation and strangulation of the cecum (Richter’s hernia) between the internal and external oblique muscles through the linea semilunaris (Spigelian hernia). The challenging clinical diagnosis of Spigelian hernias and their surgical treatment options are discussed. [Copyright &y& Elsevier]