Spigelian hernia in the right upper abdominal wall: a case report

Abstract

BackgroundSpigelian hernia (SH) is rare and constitutes less than 2% of all hernias. It is reported that more than 90% of SHs lie in the “Spigelian belt”, but SH in the upper abdominal wall is extremely uncommon. Here, we report a case of SH in the right upper quadrant of abdomen.Case presentationA 38-year-old female was admitted to hospital with complaints of abdominal pain and right upper quadrant mass for 10 days. Contrast-enhanced computed tomography (CECT) of abdomen revealed the dilated small intestine between the swelling ventral muscles in the right upper abdominal wall which suggested a ventral hernia. The surgeons considered it was a spontaneous hernia because there was no history of surgery or trauma in the upper abdomen. About two hours later, the patient underwent emergency surgery. According to laparotomy, a diagnosis of SH with ileum herniation in the right upper abdominal wall was confirmed. The necrotic ileum segment was resected. Meanwhile the abdominal wall defect was repaired by suturing the internal oblique and transverse muscles to the rectus sheath. The patient had a favorable outcome for 1 year without recurrence.ConclusionA mass and pain in the upper abdominal wall may suggest an atypical SH. SH occurring in the upper abdominal wall is a rare condition with possibility of dire outcome if not managed early.Electronic supplementary materialThe online version of this article (10.1186/s12893-018-0449-5) contains supplementary material, which is available to authorized users.

Spiegel-Casseri hernia associated with bilateral inguinal hernia. Case report

“…Ante la sospecha clínica de esta entidad, la ecografía es de utilidad, accesible y económica, aunque la TC es superior, ya que aporta datos como el tamaño del defecto, las características del saco y de su contenido, las relaciones anatómicas y no es operador dependiente, lo que la convierte en la prueba de elección [10][11][12] . A pesar de los grandes aportes de la ecografía y de la TC, existe un pequeño grupo de pacientes con HSC sintomáticos y estudios normales de imagen en el que el diagnóstico se confirma solo en la exploración quirúrgica 1 .…”

Spigelian Hernia

“…Spigelien's belt is an area about 6 cm wide above a transverse line that passes through the anterior superior iliac spines [5][6][7]. The higher incidence of hernias in this location is associated with the fact that in this location the posterior sheath of the rectus abdominis is absent and the fibers of the transversus abdominis and internal oblique muscle are in cross-parallel, making it a weakness point [5][6][7][8]15]. This does not happen above the umbilicus where there is the posterior sheath of the rectus abdominis and the fibers of the transversus abdominis and internal oblique muscles cross perpendicularly [6,7].…”

“…Concerning acquired defects, these can be associated with situations that increase intra-abdominal pressure, trauma or degeneration of the abdominal wall aponeurosis [6][7][8]15].…”

“…Due to the high risk of incarceration (25%) [4,6,7], this type of hernia is indicated for surgery [4,5,7,9,11,12]. The surgery can be performed openly or laparoscopically, with or without mesh placement [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Currently, the laparoscopic approach is increasingly used as it is associated with low morbidity rates [2-6, 8, 9, 13, 14].…”

Giant intraparietal inguinal hernia misdiagnosed as spigelian hernia in an old woman

“…A Spigelian hernia is defined as a hernia occurring through the Spigelian aponeurosis. The herniation occurs through slit-like defects in the aponeurotic layer between the rectus abdominis muscle medially and the semilunar line laterally (so-called Spigelian fascia) [ 3 ]; it constitutes less than 2% of all hernias and is reported that more than 90% lie in the “Spigelian belt”[ 4 ]. Intraparietal inguinal hernias mimic Spigelian hernias clinically; although its treatment is very simple but pre-operative diagnosis is really a challenging issue [ 2 ].…”