Spigel hernia: a single center experience in a rare hernia entity

Perrakis, Aristotelis; Velimezis, Georgios; Kapogiannatos, Georgios; Koronakis, Dimitrios; Perrakis, Evangelos

doi:10.1007/s10029-012-0925-2

“…1 Spigelian hernias usually present at crossing point of semiluminar (spigelian) and arcuate (Douglas) lines. Commonest symptoms are intermittent nonspecific pain and a bulging mass.…”

Section: Discussionmentioning

confidence: 99%

Endometriosis in a Spigelian Hernia Sac: An Unexpected Finding

Moris¹,

Michalinos²,

Vernadakis

³

2015

International Surgery

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Describes the existence of endometrioma in a spigelian hernia sac. Spigelian Hernia is a rare ventral hernia, presenting difficulties in diagnosis and carrying a high incarceration and obstruction risk. Endometriomas occur due to implantation of endometrial cells into a surgical wound, most often after a cesarean delivery. A 37-yearold woman presented to our department with persistent abdominal pain, exacerbating during menses, and vomiting for 2 days. Physical examination revealed a mass-like lesion in the border between the left-upper and left-lower quadrant. Ultrasound examination was inconclusive and a computed tomography scan of the abdomen revealed an abdominal wall mass. During surgery, a spigelian hernia was found 5 to 7 cm above a previous cesarean incision. Tissue like ''chocolate cysts'' was present at the hernia sac. Hernia was repaired while tissue was excised and sent for histological examination that confirmed the diagnosis. Spigelian hernia is a hernia presenting difficulties in diagnosis and treatment. Endometrioma in a spigelian hernia sac is a rare diagnosis, confirmed only histologically. Clinical suspicion can be posed only through symptoms and thorough investigation.

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“…A search using OvidSP and PubMed with the terms 'Spigelian hernia' and 'bilateral' in the title/abstract revealed five articles reporting bilateral cases of Spigelian hernias after excluding those not written in the English language and those reporting congenital paediatric cases. [1][2][3][4][5] Both the laparoscopic and the open approach in their management have been reported. Naik et al describe a case of bilateral hernias in an elderly man that were repaired laparoscopically using two-layered Prolene ® meshes 3 while Safioleas et al describe a more traditional open approach in a middle aged woman.…”

Section: Case Historymentioning

confidence: 99%

Acute management of a unilateral incarcerated Spigelian hernia in a patient with bilateral Spigelian hernias

Vannahme

¹

,

Monkhouse

²

2013

Ann R Coll Surg Engl

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Spigelian hernias were first described by Joseph Klinkosch in the 18th century, and have since posed a diagnostic and surgical problem owing to their non-specific presentation and rarity. While the management of unilateral hernias is fairly well described in today's literature, bilateral Spigelian hernias are very rare. We describe the emergency management of a patient with bilateral Spigelian hernias, diagnosed on computed tomography. case historyA 52-year-old woman was admitted to the surgical assessment unit after having developed right iliac fossa pain over the previous 12 hours. The onset was gradual and the pain had worsened with time. She had noticed a swelling over the right side. She had opened her bowels normally that day and, despite being nauseated, she had not vomited. She had no urinary or gynaecological symptoms. The patient was otherwise fit and well, and had not undergone any previous surgery. She was on no regular medication. She smoked 15 cigarettes a day and drank alcohol rarely. On arrival, the patient's vital observations were entirely normal. Examination revealed a very tender right iliac fossa with voluntary guarding. There was a distinct 10cm x 10cm smooth mass palpable, which appeared to be intra-abdominal rather than in the abdominal wall. This was particularly tender and did not have a cough impulse. The remainder of the abdomen was soft. Rectal examination revealed an empty rectum. Her routine blood results on admission were within the normal limits and an arterial blood gas showed a normal lactate level of 0.9mmol/l.In view of the rapid onset of symptoms and despite the lack of inflammatory features, the main differential diagnosis at this stage was an appendicular mass and computed tomography (CT) was organised. This revealed bilateral Spigelian hernias (Figs 1 and 2). The left contained small bowel loops and the descending colon. The right contained the caecum and ileum with surrounding fat stranding, suggesting the presence of reactive inflammatory changes.A laparoscopy was performed and reduction of the rightsided hernia (Fig 3) was attempted. The left side had reduced prior to surgery. The plan was to repair both hernias simultaneously at laparoscopy. Unfortunately, this was not possible as it was impossible to reduce the incarcerated caecum safely. A midline laparotomy incision was made and the hernia reduced manually via an intra-abdominal approach. The caecum, appendix and terminal ileum were extracted and deemed viable. The right-sided peritoneal defect was plicated using 3/0 Vicryl ® (Ethicon, Somerville, NJ, US) interrupted sutures. The midline incision was then closed in a standard fashion. A transverse incision was made over the right hernial orifice and the defect repaired with size 0 Prolene ® (Ethicon) continuous sutures. The left hernia was not fixed on this occasion. discussion Spigelian hernias were first described by Joseph Klinkosch in the 18th century.

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“…A paper from 2012 describing 16 cases of Spigelian hernias reported that half of the cases required emergency repair. 2 Management of bilateral hernias is more complex as very few cases are described in the literature. A search using OvidSP and PubMed with the terms 'Spigelian hernia' and 'bilateral' in the title/abstract revealed five articles reporting bilateral cases of Spigelian hernias after excluding those not written in the English language and those reporting congenital paediatric cases.…”

Section: Case Historymentioning

confidence: 99%

Acute management of a unilateral incarcerated spigelian hernia in a patient with bilateral spigelian hernias

Vannahme

¹

,

Monkhouse

²

2013

annals

View full text Add to dashboard Cite

Spigelian hernias were first described by Joseph Klinkosch in the 18th century, and have since posed a diagnostic and surgical problem owing to their non-specific presentation and rarity. While the management of unilateral hernias is fairly well described in today's literature, bilateral Spigelian hernias are very rare. We describe the emergency management of a patient with bilateral Spigelian hernias, diagnosed on computed tomography. case historyA 52-year-old woman was admitted to the surgical assessment unit after having developed right iliac fossa pain over the previous 12 hours. The onset was gradual and the pain had worsened with time. She had noticed a swelling over the right side. She had opened her bowels normally that day and, despite being nauseated, she had not vomited. She had no urinary or gynaecological symptoms. The patient was otherwise fit and well, and had not undergone any previous surgery. She was on no regular medication. She smoked 15 cigarettes a day and drank alcohol rarely. On arrival, the patient's vital observations were entirely normal. Examination revealed a very tender right iliac fossa with voluntary guarding. There was a distinct 10cm x 10cm smooth mass palpable, which appeared to be intra-abdominal rather than in the abdominal wall. This was particularly tender and did not have a cough impulse. The remainder of the abdomen was soft. Rectal examination revealed an empty rectum. Her routine blood results on admission were within the normal limits and an arterial blood gas showed a normal lactate level of 0.9mmol/l.In view of the rapid onset of symptoms and despite the lack of inflammatory features, the main differential diagnosis at this stage was an appendicular mass and computed tomography (CT) was organised. This revealed bilateral Spigelian hernias (Figs 1 and 2). The left contained small bowel loops and the descending colon. The right contained the caecum and ileum with surrounding fat stranding, suggesting the presence of reactive inflammatory changes.A laparoscopy was performed and reduction of the rightsided hernia (Fig 3) was attempted. The left side had reduced prior to surgery. The plan was to repair both hernias simultaneously at laparoscopy. Unfortunately, this was not possible as it was impossible to reduce the incarcerated caecum safely. A midline laparotomy incision was made and the hernia reduced manually via an intra-abdominal approach. The caecum, appendix and terminal ileum were extracted and deemed viable. The right-sided peritoneal defect was plicated using 3/0 Vicryl ® (Ethicon, Somerville, NJ, US) interrupted sutures. The midline incision was then closed in a standard fashion. A transverse incision was made over the right hernial orifice and the defect repaired with size 0 Prolene ® (Ethicon) continuous sutures. The left hernia was not fixed on this occasion. discussion Spigelian hernias were first described by Joseph Klinkosch in the 18th century.

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Spigel hernia: a single center experience in a rare hernia entity

Abstract: SH is a rare entity with a wide clinical spectrum and difficulties in preoperative diagnosis. Once the diagnosis of SH is established, a surgical treatment is indicated because of the high complication risk.

Cited by 16 publications

References 27 publications

Endometriosis in a Spigelian Hernia Sac: An Unexpected Finding

Endometriosis in a Spigelian Hernia Sac: An Unexpected Finding

Acute management of a unilateral incarcerated Spigelian hernia in a patient with bilateral Spigelian hernias

Acute management of a unilateral incarcerated spigelian hernia in a patient with bilateral spigelian hernias

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