Spigelian hernia: diagnosis by high-resolution real-time sonography

Abstract

The purpose of this study was to demonstrate the role of high‐resolution real‐time sonography in the diagnosis of spigelian hernias. The sonographic findings in three patients, two of whom had surgical confirmation, are presented. We also discuss and demonstrate the anatomic and pathologic factors that predispose to these hernias. In all three cases, real‐time high‐resolution sonography was very helpful in providing detailed images of the abdominal wall defect, the hernial sac and contents, and the relationship of the contents to the spigelian fascia and the rectus, external oblique, and internal oblique muscles. The role of the Valsalva and other provocative maneuvers in demonstrating the "in and out" sliding movement of the contents of the hernia also is discussed. Although the number of cases in our study is small, we think that this modality may be the most effective means for establishing this diagnosis, especially in cases with equivocal clinical findings.

Spigelian hernia: Personal experience and review of the literature

“…In those cases of diagnostic doubt is advisable to perform a sonography or tomography (13,14). These techniques can help to make a diagnosis and specially can provide data on the exact location of the defect, size, environment and hernia sac content.…”

Open vs Laparoscopic Repair of Spigelian Hernia

“…Diagnosis of spigelian hernia must be based on a proper clinical history and a thorough physical examination, and it is advisable to perform an ultrasonogram or computed tomography in cases in which there is diagnostic doubt. 1,3,[11][12][13][14] Imaging techniques give us the exact location of the defect, size, environment, and sac contents, ie, important information for properly choosing the surgical approach. If a preoperative diagnosis can be established properly, we can consider a surgical treatment suited to the characteristics of the patient and the type of hernia.…”

Hérnia de Spiegel bilateral: relato de caso e revisão de literatura

“…Entretanto, a modalidade de escolha para o seu diagnóstico é a ultra-sonografia. Com o uso de aparelhos de alta resolução em tempo real, usando Valsalva ou outros métodos provocativos, pode-se demonstrar o movimento de entrada e saída do conteúdo herniário, mesmo em situações em que o conteúdo não está encarcerado 6 . Em contraste, imagens estáticas com a tomografia ou ressonância são menos confiáveis para se detectar as hérnias spigelianas.…”