Appendicitis in a Spigelian hernia: an unusual cause for a tender right iliac fossa mass

Spigelian hernia containing an appendix

This case report presents a case of a Spigelian hernia containing an appendix, with no signs of appendicitis or ischaemia of the appendix, as shown in figure 1. This rare cause of longstanding abdominal pain and bloating can be difficult to identify before CT imaging, however, it can be safely managed operatively without removal of the appendix.

Peri-appendicular Abscess in a Spigelian Hernia

Background Spigelian hernias are a rare type of lateral ventral abdominal hernia and their content can include any of the intra-abdominal organs. Many cases have described the presence of a variety of abdominal organs in Spigelian hernias, but only few cases report the presence of an incarcerated appendicitis. Imaging is an important step in the diagnosis to avoid the lack of knowledge in such cases. Surgical treatment can be through open or laparoscopic approach, with or without using a mesh according to the size of the defect.

Case Report We report a case of an 82-year-old patient who presented with an acute appendicitis with peri-appendicular abscess strangulated in a right Spigelian hernia. The patient was successfully treated by a laparoscopic appendectomy, a surgical drainage of the abscess, and direct muscle approximation without using of mesh due to inflammation.

Conclusion Spigelian hernias with acute appendicitis in their content are a very rare condition. Clinical diagnosis is usually difficult and challenging and computed tomography scan is the imaging modality of choice. The treatment is surgical.

Gangrenous appendicitis contained within a Spigelian hernia

A 66-year-old man with abdominal pain had a 5-year-old mass subsequently identified as a Spigelian hernia. Exploratory laparotomy revealed a strangulated and gangrenous appendix contained within the hernia, necessitating an appendectomy. This case highlights the importance of early identification and exploration of this rare hernia, so that early management can prevent the development of more serious and dangerous symptoms.

A rare presentation of Spigelian hernia involving the appendix

Spigelian hernia (SH) is a rare entity accounting for 1–2% of ventral abdominal wall hernias. Elusive clinical signs and symptoms pose a diagnostic challenge and a consequent risk of strangulation. We present an emergent case of a Spigelian hernia involving the appendix.

An unusual presentation of an incarcerated Spigelian hernia

Spigelian hernias are rare hernias, occurring through a defect in the Spigelian aponeurosis. Like other hernias, they may contain abdominal contents but are more likely to be incarcerated due to the small size of the fascial defect. Multiple intra-abdominal organs have reportedly been found in Spigelian hernias. A search of the literature showed only nine reported cases in which an appendix has been found within a Spigelian hernia. We present a patient with a history of lower abdominal pain since 10 weeks with a large intra-abdominal mass in the right iliac fossa. Due to abscess formation with spontaneous evacuation through the abdominal wall, drainage and incision were performed and the patient was treated with broad-spectrum antibiotics. An explorative laparoscopy after six weeks showed an incarcerated appendix in a Spigelian hernia.