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Spigelian hernias are generally considered to occur through solitary defects in the fascial layers of the anterior abdominal wall in the ‘Spigelian hernia belt’ but can be found anywhere along the line of the linea semilunaris. They are uncommon in children and in adults thought to be acquired and associated with obesity. We describe an unusual case of Spigelian herniation previously unreported and possibly previously unrecognised.

Highlights • 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., 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.

Background: Is to describe the pathological, clinical and radiological features of Spigelian hernia, and to compare between open and laparoscopic methods of its surgical treatment. Patients and methods: We describe the clinical management of 20 cases of Spigelian hernias as regard patient complaint, clinical examination, radiological investigations, and the surgical approach that was randomly performed either open or laparoscopic intraperitoneal only mesh. Results: In all cases, the suspicion aroused during the clinical examination of the patients, and it was confirmed via imaging techniques. 10 cases were treated through open surgical approach, no intraoperative or postoperative complications have occurred, 3 patients had postoperative small wound seroma which resolved spontaneously, Other10 cases were treated through laparoscopic intraperitoneal onlay mesh repair with no intraoperative or postoperative complications. No recurrences had been observed for both groups in 24 months period of the study. Conclusion: Spigelian hernia is a rare entity; its diagnosis is depending on a thorough clinical examination and must be confirmed by imaging studies especially CT scan which is the modality of choice for its diagnosis. Open surgical repair is considered the standard method for treatment due to its rarity but laparoscopic intraperitoneal onlay mesh repair is also safe and effective with shorter postoperative hospital stay.

INTRODUCTION AND OBJECTIVE:An association between abdominal wall defects and cryptorchidism has long been noted in the medical literature. Spigelian hernia (SH), although uncommon in pediatrics, is...

A Spigelian hernia is a very rare hernia, making up approximately 0.1% of all abdominal wall hernias. This hernia goes through a defect in the Spigelian fascia which is the part of the transversus abdominis aponeurosis lateral to the rectus muscle, often at the level of the arcuate line, where the fascia is widest and weakest. We present the case of a 77-year-old female with no past surgical history who presented to our teaching hospital with high-grade small bowel obstruction secondary to an incarcerated Spigelian hernia. She was taken to the operating room for a laparotomy and a portion of the small bowel mesentery was found to be strangulated. The hernia was reduced, and the defect was repaired primarily. The diagnosis of a Spigelian hernia can often be difficult to diagnose on history and physical examination alone, but computed tomography (CT) imaging can be a valuable adjunct in diagnosis. Prompt surgical treatment should ensue when the diagnosis of high-grade bowel obstruction is made in a patient with imaging findings consistent with a Spigelian hernia.

Highlights • Cancers that occur within the abdomen and pelvis may present within a hernia. • Cancer presenting within a Spigelian hernia has not been previously reported. • Malignant peritoneal mesothelioma presented within a Spigelian hernia. • Peritoneal mesothelioma progressed rapidly within a hernia sac., Background Gastrointestinal cancer, gynecologic cancer and malignant peritoneal mesothelioma may disseminate widely to the surfaces of the abdomen and pelvis. In some patients this spread of the disease may find its way into a hernia sac. Methods The Spigelian hernia is caused by a protrusion of the peritoneum of the anterior abdominal wall into the abdominal wall muscle. This peritoneal defect occurs through the semilunar line of Spiegel in or closely associated with the semicircular line of Douglas. Results A patient presented with a large (11 cm greatest diameter) mass in the left lower quadrant. The mass was composed of malignant peritoneal mesothelioma and was anatomically located within the Spigelian hernia belt. At the time of cytoreductive surgery numerous other sites of malignant peritoneal mesothelioma were present within the abdomen and pelvis. Conclusions The left lower quadrant mass was a malignant peritoneal mesothelioma presenting within a Spigelian hernia defect. This phenomenon has not been previously reported.

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., Highlights • 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.

A spigelian hernia is considered as a diagnostic challenge . Although abdominal imaging may be helpful, the ndings of unusual abdominal complaints in the proper anatomic location should alert one to the possibility of a spigelian hernia. Incidence of spigelian hernia ranges from about 0.1% to 2% of all abdominal wall hernias. As spigelian hernias are clinically elusive , we report this rare encounter of a left sided spigelian hernia in a 50 years old female patient and its management.

Highlights • We report a case of bilateral inguinal herniae and concurrent Spigelian hernia in an adult. • Radiological diagnosis was confirmed with a CT scan. • First case report of intra-corporeal suturing of the Spigelian hernia neck. • Laparoscopic repair was performed on all three herniae through a TAPP approach., 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.

Highlights • The finding of both sliding and strangulating spigelian hernia is rare. • Nylon darning was used for the repair rather than mesh because it was a clean contaminated surgery. • The approximation was the conjoint tendon to rectus sheath after primary closure of defect., Introduction Spigelian hernia is uncommon and frequently presents with features of intestinal obstruction. Clinical diagnosis is difficult in patients without obvious abdominal mass and a computed tomography scan is very helpful in making diagnosis. We report a patient who presented with a strangulated sliding left sided spigelian hernia who was pre-operatively diagnosed and successfully managed surgically. Presentation of case A 56-year-old woman was to referred to the surgical emergency unit of our institution with abdominal swelling and pain of three days. There was no abdominal distension or fever and had no history of recurrent abdominal pains, abdominal swelling or surgery. Examination revealed a middle aged woman with a tender mass measuring about 10 cm by 8 cm in the left iliac fossa region of the abdomen. Bowel sounds were hyperactive and digital rectal examination revealed an empty rectum consistent with the diagnosis of acute intestinal obstructions. Investigations done by the patient at the referring hospital included a computed tomography (CT) scan which was suggestive of an obstructed Spigelian hernia with the sac containing a small bowel loop and mesentery. She had emergency herniorrhaphy and findings were herniation through a facial defect of about 5 cm by 4 cm along the lateral border of the rectus sheath with the hernia sac containing sero-sanguineous peritoneal fluid, gangrenous ileal segment and part of herniated urinary bladder forming the lower wall of the sac. Resection of gangrenous bowel with an end to end anastomosis was carried out, viable contents of the sac were reduced and defect repaired with interrupted non absorbable sutures to approximate the internal oblique and transversus abdominis to rectus sheath. In addition, nylon darning from inguinal ligament to the rectus sheath was also done. Her post-operative recovery was satisfactory and she remained well six months after surgery. Conclusion Pre-operative diagnosis of strangulated Spigelian hernia is difficult but can be aided by a CT. The use of nylon darning to re-inforce the repair can be rewarding where mesh cannot be used or unavailable.

Spigelian hernia occurs through slit like defect in the anterior abdominal wall adjacent to the semilunar line. Most of spigelian hernias occur in the lower abdomen where the posterior sheath is deficient. The hernia ring is a well-defined defect in the transverses aponeurosis. The spigelian hernia is rare with an incidence range from 0.12% to 2% of all abdominal wall hernias. Spigelian hernia presenting as Richter-type with acute abdomen is very rare.

Patient: Male, 62 Final Diagnosis: Spigelian hernia Symptoms: Abdominal discomfort Medication: — Clinical Procedure: Hernia repair and colonoscopy Specialty: Gastroenterology and Hepatology Objective: Mistake in diagnosis Background: While it is well known that abdominal wall hernias can pose obstacles for colonoscopy, these may not be obvious in obese patients, particularly when the hernia is in an unusual place. Case Report: A 62-year-old man presented with inability to complete colon cancer screening by means of colonoscopy or barium enema. On exam, he was noted to have a Spigelian hernia present in his left lower quadrant abdominal wall. CT colonography identified incarcerated sigmoid colon within the hernia accounting for his inability to complete colonoscopy or barium enema. Repair of his Spigelian hernia was thus performed, allowing for ease of future colorectal cancer screening. Conclusions: Colorectal cancer screening is an evidence-based benchmark for effective primary care, but is often ordered and interpreted like a blood test, without reference to the technical aspects of the procedure. Failure of colonoscopy requires examination of the patient and consideration of why the procedure failed. In particular, patients in whom colonoscopy fails must be carefully evaluated for occult partially obstructing hernias.

Spigelian hernias are a rare type of lateral ventral hernia that arises through a defect in the spigelian fascia within the anterior abdominal wall. This type of hernia can be either congenital or acquired. Herniation occurs due to weakness or a defect in the transversus aponeurotic layer between the rectus abdominis muscle medially and the semi-lunar line laterally. Due to difficulty in accurately diagnosing spigelian hernias and the risk of strangulation of herniated contents, surgical repair is often recommended. A spigelian hernia case is presented in which sonography was used in the assessment and diagnosis of the abnormality. The case report highlights important diagnostic features for differentiating a spigelian hernia from other forms of abdominal wall hernia so that proper diagnosis and surgical repair can be accomplished.

Indirect inguinal hernias are the most commonly incarcerated hernias in children, with a higher incidence in low birth weight and premature infants. Contralateral groin exploration to evaluate for a patent processus vaginalis or subclinical hernia is controversial, given that most never progress to clinical hernias. Most indirect inguinal hernias can be reduced nonoperatively. It is recommended to repair them in a timely fashion, even in premature infants. Laparoscopic repair of incarcerated inguinal hernia repair is considered a safe and effective alternative to conventional open herniorrhaphy. Other incarcerated pediatric hernias are extremely rare and may be managed effectively with laparoscopy.

We discuss here the case of a unique case of a complicated Spigelian hernia with incarcerated appendicitis presenting with a local cellulitis in the general emergency unit of a French hospital. Here, a local approach was performed and the appendicitis was operated on the site of the observed cellulitis, allowing the surgeon to take care of both the cellulitis, appendicitis and 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

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.

Intraparietal inguinal hernias are a rare variant of inguinal hernia in which the hernia sac lies between the layers of the abdominal muscles. Intraparietal inguinal hernias mimic Spigelian hernias clinically; the diagnosis presents superior difficulties than its treatment. We report a case of a giant intraparietal hernia misdiagnosed as a Spigelian hernia clinically. The patient was 83 years old woman presented with complain of a large swelling over right abdomen for around 25 years. The patient had a huge mass of 25 x 30 cm occupying right flank, right lumbar region extending up to the umbilicus and inguinal region, partially reducible with gurgling sounds. Surgery started with transversal incision over the mass, it was found to be an interstitial variety of intraparietal inguinal hernia with a long viable segment of the small bowel with their mesentery as content of the sac. Hernioplasty with a polypropylene mesh was achieved satisfactorily. The patient was discharged on third postoperative day without complications. It is challenging to diagnose intraparietal hernias preoperatively; intraoperative findings defined its definitive diagnosis and its surgical technique.

Abdominal wall hernias are one of the most common reason for surgery globally. Spigelian hernia is a rare kind of this disease with an incidence of less than 2%. Because of its unic anatomical characteristics, it can be misdiagnosed or overlooked by physicians. Developments in radiological diagnostic tools facilitate correct and early diagnosis. Herein we presented a 76 year-old Spigelian hernia case and discussed anatomical characteristics, diagnosis and treatment methods of this rare kind of hernia with the literature knowledge.

Spigelian hernia represents a rare entity. Traditionally, it was repaired by the open technique. Various laparoscopic techniques have emerged periodically. Most laparoscopic repairs use the technique of placing an intraperitoneal onlay mesh (IPOM). There is currently a tendency to close the hernia defect.A 68-year-old man was admitted to our hospital complaining of vague abdominal pain and discomfort. Physical examination revealed a bulky palpable mass on the left side of the patient. Computed tomography of abdomen revealed a left-sided incarcerated spigelian hernia containing bowel. The aim of this study was to report an educational video providing a successful laparoscopic IPOM-plus technique with muscles approximation of spigelian hernia repair step by step.Total operative time was 120 minutes. The postoperative period was uneventful. The patient reported no pain and the cosmetic result was excellent. No bulging or seroma was noted. The patient was discharged on postoperative day 1.The IPOM-plus technique may improve the outcome of spigelian hernia repair.

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.