Spigelian hernia in gynaecology

Abstract

BackgroundA Spigelian hernia is a rare hernia through the Spigelian fascia between the rectus muscle and the semilunar line. This hernia is well known in surgery. Symptoms vary from insidious to localised pain, an intermittent mass and/or a bowel obstruction.ResultsThe Spigelian hernia is poorly known in gynaecology. Spigelian hernias may be causally related to secondary trocar insertion. This review is written to increase awareness in gynaecology and is illustrated by a case report in which the diagnosis was missed for 4 years even by laparoscopy. Smaller hernias risk not to be diagnosed and will thus not be treated. Even larger Spigelian hernias might not be recognised and treated appropriately.ConclusionsThe gynaecologist should consider a Spigelian hernia in women with localised pain in the abdominal wall lateral of the rectus muscle some 5 cm below the umbilicus. Smaller hernias can be closed by laparoscopy without a mesh. Larger hernias require a mesh repair.

Rare Case of Incarcerated Bilateral Spigelian Hernia in Ghana: A Case Report and Literature Review

“…This makes it a rare clinical occurrence. The symptoms can be insidious, but pain and a lump in the abdominal wall are the commonest symptoms [4,6,7,8,9,10]. Ussia et al illustrated herniation through previous trocar insertion points, so a high index of suspicion is needed in people with a history of laparoscopic procedures presenting with pain and no identifiable organ pathology [8].…”

“…The male to female ratio is 1:1.18 [5]. The symptoms at presentation could be vague but the commonest are pain and lump/protrusion in the abdominal wall [4,6,7,8,9,10].…”

“…Spigelian hernia sometimes poses extreme diagnostic challenges to the physician because of the vague nature of symptoms [2,4,6,8,10,11,12]. Diagnosis can be made through clinical assessment but when in doubt, ultrasonography and contrast enhanced CT (CECT) scan can be used for confirmation [4,9,11].…”

Hernia de Spiegel como causa de obstrucción intestinal de íleon en una paciente anticoagulada por fibrilación auricular, abordaje laparoscópico. Reporte de caso.

“…Otro factor importante es la cirugía previa: varias publicaciones describieron la relación de aparición de HS con intervenciones quirúrgicas anteriores, mayoritariamente por vía laparoscópica 3,7 . En este trabajo, en el que describen una serie de 201 pacientes intervenidos por vía laparoscópica, encontraron un 2 % de HS, mientras que en este caso clínico los autores sugirieron que hasta en el 50 % de los casos de hernia de Spiegel existen antecedentes de cirugía abdominal previa 8,9 .…”

“…La hernia de Spiegel o hernia Spigeliana (HS) es una patología infrecuente, suponiendo aproximadamente un 1-2 % de todas las hernias de la pared abdominal 1,2 . No está descrita una etiología específica para este tipo de hernia, si bien existen factores de riesgo que predisponen a su aparición, tales como la obesidad y la pérdida rápida de peso, embarazos múltiples, EPOC, y cirugías previas, sobre todo laparoscópica 3 . Este último factor, aunque poco descrito, podría ser un factor causal de la aparición de la HS.…”