1
|
Navandhar PS, Gharde P, Shinde RK, Nagtode T, Sapkale B, Kulkarni V. Complex Hernia Presentation: A Case Study of Concurrent Spigelian and Pantaloon Hernias in a 49-Year-Old Female. Cureus 2024; 16:e60070. [PMID: 38860070 PMCID: PMC11163865 DOI: 10.7759/cureus.60070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 05/10/2024] [Indexed: 06/12/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Pratik S Navandhar
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pankaj Gharde
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Raju K Shinde
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tushar Nagtode
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Bhagyesh Sapkale
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Varun Kulkarni
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
2
|
Kavya SS, Shaikh FA, Shaikh H, Mushahid H, Sydhom M, Nadeem A. Giant spigelian hernia in a middle-aged female: The importance of intraoperative ultrasonography for hernia localization-Case report. SAGE Open Med Case Rep 2024; 12:2050313X241249099. [PMID: 38665933 PMCID: PMC11044791 DOI: 10.1177/2050313x241249099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Spigelian hernia is a rare type of abdominal wall hernia that accounts for only 0.12% of all abdominal hernias. A Spigelian hernia, also known as a spontaneous lateral ventral hernia or a hernia of the semilunar line, occurs when a part of the abdominal contents protrudes through the Spigelian fascia. Due to its anatomical location, Spigelian hernia can be difficult to diagnose through physical examination alone. Here we report a case of a 40-year-old female who experienced right abdominal pain and swelling, where ultrasonography imaging was crucial in the intraoperative diagnosis of Spigelian hernia. The patient underwent laparotomy mesh repair to address the condition. The lack of consistent physical findings and the rarity of the disease require a high level of clinical suspicion in the diagnosis of a Spigelian hernia. Its associated abdominal complaints are often vague and nonspecific, making it even more challenging. This case emphasizes the importance of utilizing imaging techniques to aid in the diagnosis of a Spigelian hernia and prompt surgical intervention to prevent complications associated with the hernia.
Collapse
Affiliation(s)
- Sanka Sai Kavya
- Department of General Surgery, SVS Medical College, Yenugonda, India
| | | | - Humaira Shaikh
- Shadan Institute of Medical Sciences and Research, Peeramchuru, Telangana, India
| | - Hasan Mushahid
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Mark Sydhom
- Department of Medicine, Ain Shams University, Cairo, Egypt
| | - Abdullah Nadeem
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| |
Collapse
|
3
|
Shrestha P, KC G, Acharya B, Shah SR, Regmee S. Spigelian Hernia: A Case report. JNMA J Nepal Med Assoc 2024; 62:145-147. [PMID: 38409978 PMCID: PMC10924510 DOI: 10.31729/jnma.8440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Indexed: 02/28/2024] Open
Abstract
A Spigelian hernia is a hernia through the Spigelian fascia which are difficult to diagnose as they do not present with a subcutaneous swelling and can be dangerous as there is a high risk of incarceration. We report a case of a 51-year-old female who presented to our surgical unit with epigastric pain for 5 days. She was diagnosed with Spigelian hernia with esophagitis and antral gastritis with the help of a computed tomography scan and upper gastrointestinal endoscopy. The diagnosis was confirmed on diagnostic laparoscopy and transabdominal preperitoneal repair of the defect was performed using prolene mesh. Her post-operative period was uneventful. Spigelian hernias are rare and patients can present with atypical symptoms as in this case. Thus, imaging plays a vital role in diagnosis. Management is surgical and has good outcomes. Keywords case reports; rectus abdominis; ventral hernia.
Collapse
Affiliation(s)
- Prinsa Shrestha
- Department of General Surgery, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Gaurab KC
- Department of General Surgery, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Bidur Acharya
- Department of General Surgery, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Shiv Raj Shah
- Department of General Surgery, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Sujan Regmee
- Department of General Surgery, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| |
Collapse
|
4
|
Shtanko Y, Galtes J, Mata W. Spigelian Hernia: A Rare Ventral Hernia. Cureus 2024; 16:e55209. [PMID: 38558702 PMCID: PMC10981197 DOI: 10.7759/cureus.55209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/07/2024] [Indexed: 04/04/2024] Open
Abstract
Ventral hernias occur when abdominal contents or the peritoneum displace through a defect in the abdominal wall. Among these, spigelian hernias are an exceptionally rare subtype, representing 0.12% to 2% of all ventral hernias. This case study focuses on an 86-year-old female presenting with a ventral hernia, notably a spigelian hernia, lacking common predisposing factors. The study emphasizes the use of laparoscopic techniques for repair, aiming to offer insights into managing this infrequent hernia type and aiding clinical decision-making. Due to its low incidence and challenging diagnosis and identification, reports such as ours detailing both the clinical course and the operative steps can assist others in their clinical decision-making.
Collapse
Affiliation(s)
- Yulia Shtanko
- College of Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Juliet Galtes
- College of Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Wilmer Mata
- General Surgery, Baptist Health South Florida, Miami, USA
| |
Collapse
|
5
|
Huynh I, Lim WM, Chen MZ, Sundaramurthy SR, Tay YK. A Case Report on a Hybrid Approach to Managing Acute Large Bowel Obstruction Secondary to Spigelian Hernia. Cureus 2024; 16:e53869. [PMID: 38465056 PMCID: PMC10924684 DOI: 10.7759/cureus.53869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/12/2024] Open
Abstract
Spigelian hernias are an uncommon type of primary ventral hernia and are defined as a defect in the Spigelian aponeurosis (fascia). Herein, we present an uncommon case of Spigelian hernia to highlight the potential complications of these hernias and the need for surgical management. This is a case report of an 86-year-old gentleman presenting post-fall with an acute rib fracture and an incidental Spigelian hernia seen on a CT trauma pan scan. The Spigelian hernia surgical treatment was planned for elective management due to the anesthetic risks associated with an elderly patient and acute rib fractures. Ultimately, the patient developed a large bowel obstruction secondary to the Spigelian hernia and required emergency operative management to relieve the obstruction. The patient had an uncomplicated recovery following his emergency surgery. This case report highlights the importance of assessing anesthetic risks versus surgical risks when it comes to surgical planning. Clinicians should recognize occult hernias and continue ongoing clinical reviews with a high index of suspicion, as symptoms of Spigelian hernia obstruction might be non-specific.
Collapse
Affiliation(s)
- Isabelle Huynh
- General Surgery and Acute Surgery Unit, Monash Health, Melbourne, AUS
| | - Wei Mou Lim
- Colorectal Unit, Monash Health, Melbourne, AUS
| | | | | | | |
Collapse
|
6
|
Tien TPD, Huan NN, Trung LV. Spigelian Hernia: A Clinical Case Report. Cureus 2023; 15:e46589. [PMID: 37933366 PMCID: PMC10625788 DOI: 10.7759/cureus.46589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 11/08/2023] Open
Abstract
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. We report a case of Spigelian hernia causing an intestinal obstruction treated with surgical emergency abdominal wall reconstruction using the sublay technique. Identification and evaluation of cases with the potential for hernia occurrence are crucial for the safety of patients undergoing surgery. Spigelian hernia accounts for 1%-2% of all ventral hernia cases. Currently, there are no reports on Spigelian hernia in Vietnam. However, a few reports on surgical management of Spigelian hernia have been published worldwide, with approaches including laparoscopic and open surgery, and these reports have indicated that abdominal wall reconstruction using the sublay technique is feasible as it is associated with fewer postoperative complications and shorter hospital stays. Here, we describe the case of an 87-year-old woman presenting with swelling and pain in the lower left quadrant of the abdomen. A preoperative diagnosis of Spigelian hernia causing intestinal obstruction was established, and we proceeded with abdominal wall reconstruction using the sublay technique. The patient was discharged three days after surgery without any postoperative complications.
Collapse
Affiliation(s)
| | | | - Lam Viet Trung
- Digestive Surgery, Cho Ray Hospital, Ho Chi Minh City, VNM
| |
Collapse
|
7
|
Nguyen P, Aravindan A, Wong J. Spigelian hernia in peritoneal dialysis: The forgotten peril. Perit Dial Int 2023:8968608231198987. [PMID: 37724001 DOI: 10.1177/08968608231198987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Affiliation(s)
- Paul Nguyen
- Department of Nephrology, Liverpool Hospital, New South Wales, Sydney, Australia
| | | | - Jeffrey Wong
- Department of Nephrology, Liverpool Hospital, New South Wales, Sydney, Australia
| |
Collapse
|
8
|
Lowrie NR, Richter KK, Orizu MN. Diagnosis and treatment of a rare case of an incarcerated bilateral Spigelian hernia with the vermiform appendix and caecum. BMJ Case Rep 2023; 16:e251931. [PMID: 37553169 PMCID: PMC10414057 DOI: 10.1136/bcr-2022-251931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
Spigelian hernia is a rare form of abdominal wall defect. Bilateral Spigelian hernias are even less common. Surgical repair of Spigelian hernias is recommended due to their high risk of incarceration and strangulation of abdominal contents. A variety of surgical approaches to repair these hernias have been described in the literature including the traditional open approach, laparoscopic transabdominal preperitoneal approach, laparoscopic intraperitoneal repair and laparoscopic totally extraperitoneal repair. Here, we present the case of an elderly female patient with rare bilateral Spigelian hernias, the right side containing incarcerated appendix and caecal pole. The left hernia was unrecognised on preoperative CT imaging. To our knowledge, very few cases have been reported in the literature. The patient underwent bilateral laparoscopic intraperitoneal mesh repair. All technical aspects of the treatment are discussed here, in the context of the current literature, including the surgical technique and the limitations of the CT diagnosis. We aim to summarise the background of these uncommon hernias, the limitations of preoperative investigations and the differences between the available operative approaches.
Collapse
Affiliation(s)
- Neil Robert Lowrie
- General Surgery, University of Otago School of Medicine, Dunedin, New Zealand
- General Surgery, Southland Hospital, Invercargill, New Zealand
| | - Konrad Klaus Richter
- General Surgery, Southland Hospital, Invercargill, New Zealand
- Dean's Department, University of Otago School of Medicine, Dunedin, New Zealand
| | - Mavis N Orizu
- General Surgery, Southland Hospital, Invercargill, New Zealand
| |
Collapse
|
9
|
Kangabam B. Traumatic Spigelian Hernia Following Blunt Abdominal Trauma. Cureus 2023; 15:e35564. [PMID: 37007403 PMCID: PMC10063246 DOI: 10.7759/cureus.35564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/04/2023] Open
Abstract
Traumatic abdominal wall hernia (TAWH) is a rare form of hernia occurring after blunt trauma to the abdomen. Traumatic Spigelian hernia is an uncommon subtype sporadically described in the literature. It is an anterior abdominal wall defect occurring along the Spigelian aponeurosis bounded laterally by the semilunar line and medially by the rectus abdominis muscle. Imaging with CT is the investigation of choice. The surgeon has a variety of treatment options ranging from the traditional midline laparotomy to laparoscopic repair with or without the use of mesh. Conservative treatment has also been advocated as a safe and feasible option in select cases. Described here is a case of traumatic Spigelian hernia following blunt abdominal trauma caused by a motorcycle handlebar in a 17-year-old male.
Collapse
|
10
|
Lode L, Jensen KK, Helgstrand F, Henriksen NA. Outcomes After Spigelian Hernia Repair: A Nationwide Database Study. World J Surg 2023; 47:1184-1189. [PMID: 36749361 DOI: 10.1007/s00268-023-06923-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Spigelian hernia is a rare hernia of the abdominal wall. Due to lack of evidence, there is no standard recommendation for surgical technique of Spigelian hernia repair. The aim of this study was to evaluate the outcomes after open and laparoscopic, elective and emergency repair of Spigelian hernias on a nationwide basis. METHODS Nationwide data from the Danish Ventral Hernia Database and the National Patient Registry was assessed to analyze outcomes after Spigelian hernia repair. A total of 365 patients were operated for Spigelian hernia in Denmark from 2007 to 2018. Ninety-day readmission, 90-day reoperation and long-term operation for recurrence were evaluated, as well as possible differences between open and laparoscopic, and elective and emergency repairs. RESULTS Most of the patients (80.5%, 294/365) were operated by laparoscopic approach and 19.5% (71/365) were operated by open approach. Elective surgery was performed in 83.6% (305/365) of the patients and 16.4% (60/365) underwent emergency repair. There were no significant differences in 90-day readmission or reoperation rates between open or laparoscopic Spigelian hernia repairs, P = 0.778 and P = 0.531. Ninety-day readmission and 90-day reoperation rates were also comparable for elective versus emergency repair, P = 0.399 and P = 0.766. No difference was found in operation for recurrence rates between elective and emergency, nor open and laparoscopic Spigelian hernia repairs. CONCLUSIONS This study demonstrates that 16% of Spigelian hernia repairs are done in the emergency setting. Open and laparoscopic approach are comparable in terms of early readmission, reoperation, and recurrence rates.
Collapse
Affiliation(s)
- Lise Lode
- Department of Gastrointestinal Surgery, Hvidovre Hospital, Kettegård Alle 30, 2650, Hvidovre, Denmark.
| | | | | | - Nadia A Henriksen
- Department of Gastrointestinal- and Hepatic Diseases, Surgical Section, Copenhagen University Hospital, Herlev, Denmark
| |
Collapse
|
11
|
Spigelian hernia: current approach to surgical treatment–peculiarities in this rare condition. Hernia 2022; 26:1707-1708. [DOI: 10.1007/s10029-022-02678-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/02/2022] [Indexed: 11/04/2022]
|
12
|
Haji Rahman R, Punjwani A, Notario-Ringwald J, Taneja S, Fahim S, Varghese R, Tiesenga F. Non-strangulated Spigelian Hernia: A Case Report. Cureus 2022; 14:e27699. [PMID: 36081961 PMCID: PMC9440990 DOI: 10.7759/cureus.27699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 11/23/2022] Open
Abstract
Spigelian hernia is a rare type of ventral hernia with an incidence of 0.1-2%. We report a case of a non-strangulated left lower quadrant spigelian hernia and its management. A 74-year-old female presented with progressively worsening left flank pain along with dysuria and frequency related to pyelonephritis. Incidentally, CT of the abdomen and pelvis demonstrated a left spigelian hernia containing intermediate size small bowel without strangulation. Thereafter, she began developing increasing abdominal pain in that area. The hernia was repaired on the same day as admission via laparoscopic intraperitoneal onlay mesh-plus repair. Spigelian hernia possesses an elusive clinical presentation. Though rare, it must be considered in the differential diagnosis of abdominal hernia due to its high risk for acute complications.
Collapse
|