Spigelian Hernia : A Diagnostic Dilemma

Abstract

PURPOSE- Spigelian Hernia[SH] constitutes 0.12% to 2% of total abdominal wall hernia. The diagnosis of SH poses great difficulty because of non-specific presentation, and non obvious finding on examination. Also, Surgeons are less experienced with this entity and have low index of suspicion further contributing to underdiagnosis. Thus, whether SH is a rare entity or an underdiagnosed condition is debatable. The aim is share our experience and discuss different clinical aspects and outcomes of SH with a literature review regarding diagnostic difficulties. PATIENTS AND METHODS- This is a case series of 18 patients diagnosed with 20 SH, were operated in a single surgical unit of Sir Sunderlal Hospital from January 2016 to July 2019. Historical patient’s records including demographic profiles, clinical presentation, and management were analysed. RESULTS- Total 18 patients were admitted with women preponderance. The mean age of presentation was 39.23years. The most common presentation is pain followed by swelling. Most patients don’t have any clinical finding. Defect is identified only in 3 patients. Ultrasound, Contrast-Enhanced Computed Tomography and Magnetic Resonance Imaging were used to diagnose the hernia. All the patients were managed operatively with pre-peritoneal fat as the most frequent content. CONCLUSION- SH is a diagnostic challenge with rather simple management. A high index of clinical suspicion is the key to diagnosis. SH seems more of an under-diagnosed rather than a rare entity. Also the author suggests to scan whole length of spigelian aponeurosis whenever there is a suspicion or the failure to reach an otherwise diagnosis.