A rare presentation of Spigelian hernia involving the appendix

Abstract

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.

Strangulated sliding spigelian hernia: A case report

“…However, drawbacks include being operator dependence and reduced diagnostic accuracy in obese patients. It is advocated that scanning of the semilunar line should be done in all patients with obscure abdominal pain and swelling of the abdominal wall in both supine and erect positions and while patient performs a Valsalva maneuver to increase accuracy [4,10,11]. Presently, abdomen and pelvis CT scanning with contrast is the best and most reliable method to make the diagnosis in doubtful cases [11].…”

“…It is advocated that scanning of the semilunar line should be done in all patients with obscure abdominal pain and swelling of the abdominal wall in both supine and erect positions and while patient performs a Valsalva maneuver to increase accuracy [4,10,11]. Presently, abdomen and pelvis CT scanning with contrast is the best and most reliable method to make the diagnosis in doubtful cases [11]. It has sensitivity and PPV of 100% respectively and also provides additional information about different layers of abdominal wall and surrounding soft tissue changes.…”

“…It has sensitivity and PPV of 100% respectively and also provides additional information about different layers of abdominal wall and surrounding soft tissue changes. In addition, bowel strangulation can be better identified on a CT [11]. This imaging modality may not be readily available in resource-poor countries due to cost thereby limiting the use in diagnosis.…”

Spiegel's hernia, a rare weakness of the abdominal wall

“…L'orifice herniaire a généralement un petit diamètre de 1 à 2 cm, ce qui augmente le risque d'incarcération et de strangulation, ce risque d'étranglement pourrait atteindre 20% au moment du diagnostic (7). L'échographie peut fournir des informations sur l'orifice herniaire, le sac herniaire et son contenu, or le scanner abdominal reste plus performant en confirmant le diagnostic et objectivant la relation du contenu avec le fascia spiegélien (8)(9). La présence d'une hernie spiegélienne est une indication pour sa réparation chirurgicale.…”

Non-Operative Management of Perforated Appendicitis Within a Spigelian Hernia

“…Spigelian hernias comprise an exceedingly small minority of all abdominal hernias. 1 Usual contents are omentum or small bowel, though large bowel, stomach, gallbladder, ovary, testis, and bladder, although rare, have been described. 1,3 Yet, it is even more rare to manage an inflamed appendix within a spigelian hernia.…”