Intestinal obstruction induced by a giant incarcerated Spigelian hernia: case report and review of the literature

Abstract

A 72-year-old woman was admitted to the emergency department complaining of diffuse abdominal pain. Abdominal examination revealed a firm 10 x 10 cm tender mass in the lower left quadrant, without surrounding cellulite or tenderness. Plain abdominal radiographs displayed the formation of levels, thus indicating the existence of intestinal obstruction. An abdominal computed tomography scan clearly showed a fluid and air-filled mass in the soft tissue area of the lower left-side abdominal wall. Spigelian incarcerated hernia was diagnosed and the patient underwent emergency surgical repair by means of local incision. The large defect in the abdominal wall was closed up as successive anatomical layers, and a prosthetic polypropylene mesh was set into the lateral aspect of the rectus sheath. The postoperative course was uneventful and the patient was discharged on the seventh postoperative day.

Ventral hernia: Patient selection, treatment, and management

“…Frequently there is no appreciable bulge at the site of the hernia as the defect and its contents lie beneath the intact external oblique aponeurosis. Using the traditional open approach for repair, the skin above the hernia is marked pre-operatively and a transverse incision is made over the identified site and carried over to the external oblique aponeurosis 259,260 .…”

Spigelian hernia case report and review of literature

“…Spigelians hernias are rare. 1,4 They correspond to the protrusion of a peritoneal sac through an acquired or congenital orifice of the spigelian line. 1 The semilunar line was first described by Adriaan van der Spiegel in 1645, which corresponds to the outer lateral junction of the right abdomen muscles of the large muscles aponevroses.…”

“…1 The semilunar line was first described by Adriaan van der Spiegel in 1645, which corresponds to the outer lateral junction of the right abdomen muscles of the large muscles aponevroses. 4,6 Spigelians hernias occur at any age with peaks between 40 and 70 years old. They affect both women and men.7 It is most often encountered below the umbilic by dehiscence of transverse aponeurosis and internal oblique muscle which appear to be weaker in the marked line 6 ( Figure 2).…”

“…7 In most cases, the hernia sac contains epiploon, hail, caecum, appendix or sigmoid. 4,8 Some authors find more atypical content such as stomach, gallbladder, diverticule of Meckel, an ovarian, a uterine myoma or an endometriosis nodule. 1 The clinical diagnosis of spigelian hernia is often made difficult by obesity, either in the case of a large hernia protruding under the skin that can be confused with a lipoma, or when the hernia is small, it is hardly palpable as in the case of authors observation.…”

“…The most common complication is hernia strangulation, which causes acute intestinal occlusion. 4 As the incarceration rate of spigelian hernia is very high, prompt surgery should be performed. 5 Authors report a case of strangulated Spigelian hernia in a 48-year-old man diagnosed with abdominal computed tomography (CT) scan.…”