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Insidious abdominal pain? consider spigelian hernia: A case report

Classic clinical features include a lump or swelling in the lower abdomen along the semilunar line. This lump is most painful with extension movements of the trunk. Chronic pain is caused by pressure of the sac contents on the underlying nerves of the anterior abdominal wall that run along the internal oblique. This pain can be vague in nature with varying qualities. The clinical features of this hernia are so non-specific that less than half are diagnosed prior to surgical exploration.

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 Spigelian Hernia: A Rare Diagnosis for a Common Presentation

Spigelian hernias are rare and generally difficult to diagnose because of their location and vague non-specific symptoms. They are situated between the muscular layers of the abdominal wall and can be easily overlooked because of abdominal obesity. The diagnosis has been considerably aided by the introduction of ultrasonography and computed tomography (CT). These hernias require surgical treatment.

Articles of Interest

Diagnosis and management of Spigelian hernia: A review of literature and our experience

Spigelian hernias occurs through slit like defects in the anterior abdominal wall adjacent to the semilunar line which extends from the tip of the ninth costal cartilage to the pubic spine at the lateral edge of the rectus muscle inferiorly. Most of spigelian hernias occur in the lower abdomen where the posterior sheath is deficient. It is also called “spontaneous lateral ventral hernia” or “hernia of semilunar line”.

Living with Spigelian Hernia: What Are Your Treatment and Recovery Options?

Spigelian hernia, often termed "ventral hernia," occurs when a portion of the abdominal wall weakens or tears, allowing the underlying tissue or organs to push through. Unlike more common hernias, such as inguinal or umbilical hernias, Spigelian hernias are less prevalent but equally troublesome.

Spigelian Hernia

This type of hernia has a mandatory indication to surgical repair due to the risk of incarceration that can occur in about 25% and strangulation that can occur in about 40%. Traditionally, open surgical repair is most commonly used. However, laparoscopic approach is becoming increasingly popular

Spigelian hernia in gynaecology

Diagnosis remains a diagnostic challenge and requires a high index of suspicion given the lack of consistent symptoms and signs. Larger or symptomatic Spigelian hernia’s can be suspected by CAT scan

Spigelian Hernia: A Clinical Case Report

Spigelian hernia, also known as lateral ventral hernia, is a type of hernia arising through the Spigelian aponeurosis. Unlike many other ventral hernias that occur beneath the layer of fat and abdominal skin, Spigelian hernia is situated within the abdominal wall muscles. Spigelian hernia often presents with few symptoms and may exist for a long time without being diagnosed or detected.

Spigelian Hernia: Clinical Features and Management

The Spigelian hernia is a rare variety of ventral hernia and has an incidence ranging from 0.1–2% of all abdominal wall hernias. It occurs through a well-defined defect in the Spiegel’s fascia adjacent to the semilunar line. It can be congenital or acquired. The acquired variety is predisposed by stretching and weakening of the abdominal wall by factors that increase the intraabdominal pressure. These hernias are most commonly located in the interparietal plane with no visible or palpable mass, and only 50% of cases could be diagnosed clinically before any surgical intervention. Radiological investigations like USG and CT scans confirm the clinical diagnosis or pick up the subclinical varieties that present with non-specific pain in the anterior abdominal wall. Surgery is the mainstay of management. These hernias are prone to early incarceration and strangulation and therefore should be operated at the earliest

Spigelian hernia: Rare or obscure?

As stated by Osler, “A physician cannot make a diagnosis, unless he first thinks of the disease.” Let us hope that this hernia will be discovered on more occasions than is presently reported.

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StatPearls

A spigelian hernia is a rare, abnormal protrusion of abdominal contents or peritoneum through a defect (spigelian fascia), which is comprised of the transversus abdominis and the internal oblique aponeuroses. It typically results from an underlying pathology that increases intra-abdominal pressure, abdominal wall trauma, or degeneration of abdominal aponeurotic layers.