An incarcerated Spigelian hernia with the appendix in the sac passing though all layers of the abdominal wall: an unusual cause for chronic right iliac fossa pain

Page, Daniel; Hendahewa, Rasika

doi:10.1093/jscr/rjaa099

Cited by 3 publications

(4 citation statements)

References 5 publications

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“…However, this study showed no significant differences in readmission or reoperation rates in patients undergoing emergency hernia repair, compared to elective. This finding is in contrast to recommendations from low volume publications and case reports showing that a Spigelian hernia is associated with a high risk of incarceration and therefore recommends elective repair for all patients with Spigelian hernias [5][6][7].…”

Section: Discussioncontrasting

confidence: 92%

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Outcomes After Spigelian Hernia Repair: A Nationwide Database Study

Lode

Jensen²,

Helgstrand³

et al. 2023

World j. surg.

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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.

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Section: Discussioncontrasting

confidence: 92%

“…The diagnosis is therefore often first suspected when symptoms occur [4]. The defect of a Spigelian hernia is usually small and with sharp fascial margins, and risk of incarceration is described in the literature [5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Outcomes After Spigelian Hernia Repair: A Nationwide Database Study

Lode

Jensen²,

Helgstrand³

et al. 2023

World j. surg.

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“…However, multiple intra-abdominal organs have been reported to have been found in the SH as large bowel, stomach, gallbladder, Meckel diverticulum, ovary, testis, leiomyoma of the uterus, and even bladder [1]. The involvement of appendix has also been described in various case reports [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] (table 1).…”

Section: Epidemiologymentioning

confidence: 99%

“…Martín-Mattar [5] 2020 Necrotic appendicitis Transverse incision: appendectomy and hernioplasty with suture of aponeurosis of the external oblique muscle and sublay mesh placement of Prolene® Page [6] 2020 None Conservative management for patient's preference Sobrado [7] 2020 Intraparietal appendix in previous liver transplantation Open appendectomy and hernia repair with polypropylene mesh below the external oblique fascia Anand [8] 2020 Necrotic and perforated appendix with surrounding purulence Exploratory laparotomy revealing the distal end of the appendix going through the abdominal defect into the hernial sac. Due to the difficulty in grasping, a counterincision was made over the area of the defect.…”

Section: Author Year Intraoperative Finding Treatmentmentioning

confidence: 99%

Vermiform Appendix Incarcerated in Spigelian Aponevrosis Defect (VAISAD hernia)

Fiume¹

2022

JSCRI

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Spigelian hernia (SH) is infrequent accounting less than 2% of all abdominal hernias. The presence of vermiform appendix within the hernial sac is of further peculiarity. While the authors who first described inguinal hernia containing the appendix (Amiand’s hernia) and femoral hernia containing the appendix (De Garengeot’s hernia) are well known and their name was given to the disease, SH containing the vermiform appendix has no specific name. This study provides a literature search on this topic and a review of the available case reports is conducted. A description of a clinical case of an incarcerated SH in which the vermiform appendix was located within the hernial sac is presented with attached the video of its mini-invasive surgical treatment. Based on literature findings, an attempt is made to give a specific name to this condition (Vermiform Appendix Incarcerated in Spigelian Aponevrosis Defect) using the acronym VAISAD hernia, in such a way so that it can be specifically and easily searched. Moreover, a classification of its severity and related complications, similarly to what was done for Amiand’s hernia, is carried out in order to establish the optimal approach in the surgical treatment case by case.

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Spigelian Hernia and Appendicitis: A Rare Case Report

Eydou

Issa

Kamalakannan³

et al. 2022

NEMJ

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Introduction: Hernias containing the appendix are well-known entities that preferentially affect the groin. The presence of an appendix within a Spigelian hernia, which is a rare ventral hernia that presents with nonspecific symptoms and location, adds significantly to the complexity and rarity of its diagnosis. Further, only 18 such cases were reported and published in the literature. We report a case of Spigelian hernia and appendicitis within the hernial sac to highlight the diagnostic challenges associated with this type of hernia. Case Presentation: In her late 30s, a female who underwent laparoscopic surgery for a uterine fibroid two and a half years back presented with right lower quadrant abdominal pain for two days. This followed abdominal pain on exertion for the previous nine months. On examination, there was tenderness, guarding, and a positive cough impulse in the right lower quadrant of the abdomen. Her body mass index was 37.53 kg/m2. A contrast-enhanced computed tomography imaging of the abdomen reported a right iliac fossa incisional hernia with omental congestion necessitating an emergency laparoscopic surgery. At surgery, a Spigelian hernia, which was at least 5 cm away from the port site scar of the previous surgery, was found. The hernia contained an inflamed appendix. Thus, a diagnosis of Spigelian hernia and appendicitis within the hernial sac was made. A laparoscopic reduction and repair of the Spigelian hernia and a laparoscopic appendectomy were performed. Conclusion: Whereas Spigelian hernias are considerably rare, the presence of an appendix within a Spigelian hernia sac is yet a more infrequent occurrence. Although the imaging modalities are often inconclusive, careful interpretation of the computed tomography imaging findings may reveal the pathology preoperatively.

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An incarcerated Spigelian hernia with the appendix in the sac passing though all layers of the abdominal wall: an unusual cause for chronic right iliac fossa pain

Cited by 3 publications

References 5 publications

Outcomes After Spigelian Hernia Repair: A Nationwide Database Study

Outcomes After Spigelian Hernia Repair: A Nationwide Database Study

Vermiform Appendix Incarcerated in Spigelian Aponevrosis Defect (VAISAD hernia)

Spigelian Hernia and Appendicitis: A Rare Case Report

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