Department of Surgery, General and Oncologic Hospital of Kifissia ‘Agioi Anargyroi’, National and Kapodistrian University of Athens, Athens, Greece
* Corresponding author Email:
Spigelian hernia is a rare abdominal wall hernia. It occurs between the fascia of the anterior rectus abdominis, the internal oblique and the transverse abdominal muscles, being almost exclusively intercalated between the layers of the abdominal wall. We have presented a very rare case of Spigelian hernia penetrating the external oblique muscle and have discussed the surgical considerations through a literature review.
A 63-year old man presented complaining of abdominal pain, constipation and abdominal distension that had been ongoing for two days. Clinical examination revealed a palpable, painful mass in the right lateral abdominal wall, which augmented in size during Valsalva manoeuvre. Ultrasonographic evaluation showed protrusion of the intestinal helix in the right lateral abdominal wall, and contrast computed tomography evaluation was diagnostic of a Spigelian hernia penetrating the external oblique muscle. The patient underwent a repair of the hernia defect with the use of a mesh. There was no evidence of recurrence one year after the surgery.
Spigelian hernias are rare and carry a significant risk of incarceration and strangulation that lead to serious complications, while their clinical presentation is often vague, leading to delayed diagnosis. Primary repair has so far been the treatment of choice, while other techniques can also be considered depending on the patient’s characteristics and the hernia type. A thorough physical examination along with high clinical suspicion remains crucial in the diagnosis of the Spigelian hernia; additionally, modern imaging modalities assist in timely and accurate preoperative diagnosis. Prompt surgical treatment is the key to avoid complications.