Richter-type Spigelian hernia: A case report and review of the literature

Spigelian Hernia Masquerading as Chronic Lower Abdominal Pain: A Case Report

Spigelian hernias are rare and often overlooked causes of lower abdominal pain due to their deep location and subtle clinical signs. This case involves a 55-year-old woman with a five-year history of intermittent right lower abdominal discomfort that gradually worsened with physical activity. Clinical examination was inconclusive, prompting further evaluation with imaging, which revealed a defect in the Spigelian fascia with bowel herniation. She underwent successful open mesh repair, with an uneventful recovery and complete resolution of symptoms. This case highlights the diagnostic challenges associated with Spigelian hernias and underscores the importance of maintaining a high index of suspicion in patients with persistent, unexplained abdominal pain, as early imaging and surgical intervention can lead to excellent outcomes.

Day Surgery for Spigelian Hernia Repair Under Local Anesthesia: A “Real Minimally Invasive” Surgical Approach

Spigelian hernia (SH) represents less than 1% of all hernias and about 0,1% of abdominal wall hernias. Although it is a very rare hernia, it has a considerably high risk of strangulation. The aim of this work is to propose the open approach based on local anesthesia on a Day Surgery regimen as a safe treatment for Spigelian Hernia surgery. We report a series of 17 clinical cases (9 men and 8 women, between 40 and 80 years old) who underwent SH open repair on a Day Surgery basis between 2004 and 2021 in our University Hospital. In our single-center case series, no early postoperative complications occurred, except for a bulky seroma of about 800 cc. No prosthesis or surgical wound infections occurred and no recurrences were observed in the early postoperative period. Looking at our experience and the literature, Spigelian hernia repair under local anesthesia on a Day Surgery regimen, using a pre-peritoneal polypropylene mesh, could be proposed as a safe and “real minimally invasive” approach in elective settings.

Contrasting Presentations of Spigelian Hernia in a Single Surgical Unit of a Tertiary Healthcare Center: A Case Series

A Spigelian hernia is a very rare type of anterior abdominal wall hernia. The etiology revolves around the dehiscence of the transverse abdominis and internal oblique aponeurosis. The majority of Spigelian hernias develop in the lower abdomen where the posterior sheath is absent. This condition is also known as a spontaneous lateral ventral hernia or hernia of the semilunar line. It is mostly asymptomatic and is generally proven by radiological diagnosis. In the worst-case scenario, strangulation of the Spigelian hernia can occur. Here, we report a case series of contrasting presentations of Spigelian hernia in a single surgical unit of a tertiary healthcare center, considering the rarity and associated complications of Spigelian hernia.

Robotic Ventral Transabdominal Preperitoneal Repair of Uncomplicated Spigelian Hernia

Spigelian hernias are rare herniations through the Spigelian fascia, with an incidence rate of 0.12-2.0% of all hernias. Diagnosis may be difficult due to a potential lack of symptoms until complications arise. Therefore, imaging with either ultrasound or CT with oral contrast is recommended to confirm the diagnosis if a Spigelian hernia is suspected. Once the diagnosis has been established, it is essential that operative repair be performed as soon as possible because 24% of Spigelian hernias become incarcerated, and 27% of Spigelian hernias lead to strangulation. Management options include open surgery, laparoscopic surgery, and robotic surgery. This case report discusses the management of a 47-year-old man with an uncomplicated Spigelian hernia that was repaired with the robotic ventral transabdominal preperitoneal repair technique.

Giant intraparietal inguinal hernia misdiagnosed as spigelian hernia in an old woman

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.

Incarcerated Spigelian Hernias: A Rare Cause of a High-grade Small Bowel Obstruction

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.

Strangulated sliding spigelian hernia: A case report

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The finding of both sliding and strangulating spigelian hernia is rare.

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Nylon darning was used for the repair rather than mesh because it was a clean contaminated surgery.

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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.

Giant interparietal inguinal hernia with undescended testis-A Rare case report

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An interparietal inguinal hernia with undescended testis & obstructed external ring is a rare presentation.

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In Interperital hernia, the sac passes between the layers of the abdominal wall.

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Pre-operative diagnosis even with the help of USG & CT is really a challenging issue.

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Treatment is surgical exploration which also confirms the final diagnosis.

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.

Sonographic Assessment of a Spigelian Hernia

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.

Spigelian hernia in gynaecology

Background

A Spigelian hernia is a rare hernia through the Spigelian fascia between the rectus muscle and the semilunar line. This hernia is well known in surgery. Symptoms vary from insidious to localised pain, an intermittent mass and/or a bowel obstruction.

Results

The Spigelian hernia is poorly known in gynaecology. Spigelian hernias may be causally related to secondary trocar insertion. This review is written to increase awareness in gynaecology and is illustrated by a case report in which the diagnosis was missed for 4 years even by laparoscopy. Smaller hernias risk not to be diagnosed and will thus not be treated. Even larger Spigelian hernias might not be recognised and treated appropriately.

Conclusions

The gynaecologist should consider a Spigelian hernia in women with localised pain in the abdominal wall lateral of the rectus muscle some 5 cm below the umbilicus. Smaller hernias can be closed by laparoscopy without a mesh. Larger hernias require a mesh repair.