Incarcerated Spigelian hernia mimicking obstructing colon carcinoma

Spigelian hernia is a ventral abdominal hernia that only rarely causes incarceration or strangulation of the bowel. There are few reports in the surgical literature of colonic obstruction secondary to incarcerated Spigelian hernia. In this paper, we present a patient with an incarcerated sigmoid colon in a Spigelian hernia sac, mimicking on contrast enema an obstructing carcinoma. Accurate diagnosis was made pre-operatively by computed tomography (CT), and the hernia was repaired by polypropylene mesh in a tension-free manner.     

Colonic obstruction secondary to incarcerated Spigelian hernia in a severely obese patient

Spigelian hernia is a rare hernia of the ventral abdominal wall accounting for 1-2% of all hernias. Incarceration of a Spigelian hernia has been reported in 17-24% of the cases. We herein describe an extremely rare case of a colonic obstruction secondary to an incarcerated Spigelian hernia in a severely obese patient. Physical examination was inconclusive and diagnosis was established by computed tomography scans. The patient underwent an open intraperitoneal mesh repair. A high level of suspicion and awareness is required as clinical findings of a Spigelian hernia are often nonspecific especially in obese patients. Computed tomography scan provides detailed information for the surgical planning. Open mesh repair is safe in the emergent surgical intervention of a complicated Spigelian hernia in severely obese patients.     

Laparoscopic transabdominal preperitoneal repair of spigelian hernia.

BACKGROUND: A Spigelian hernia is a congenital defect in the transversus aponeurosis fascia. Traditionally, an anterior hernioplasty was used to repair these defects. This study aimed to document our experience with laparoscopic transabdominal preperitoneal repair for Spigelian hernia. METHODS: Eight patients underwent laparoscopic transabdominal Spigelian hernia repair. All patients underwent creation of a peritoneal flap, sac dissection, identification and approximation of the fascial defect, mesh reinforcement, and reperitonealization. RESULTS: All patients presented with pain. An intermittent palpable mass was noticed in 4 patients. One third of the patients had undergone prior surgery and none had an incisional hernia. Only 1 patient presented with severe pain for 1 day; however, there was no bowel strangulation intraoperatively. All patients underwent laparoscopic transabdominal preperitoneal repair. No postoperative complications occurred. There have been no recurrences at a mean follow-up of 41 months (range, 8 to 96). CONCLUSION: Laparoscopic transabdominal preperitoneal repair of Spigelian hernia is safe, easy, and feasible for experienced laparoscopic surgeons.     

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

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.     

Preperitoneal mesh repair of spigelian hernias under local anesthesia: description and clinical evaluation of a new technique

We report on a new method for the repair of spigelian hernia, in which we combined the step-by-step local anesthesia and open preperitoneal mesh repair techniques. After initial infiltration of local anesthetics, we incised the attenuated fascia and slightly enlarged the fascial defect to facilitate easy return of hernial content into the abdominal cavity. We injected preperitoneally, in a radial fashion around the peritoneal sac, more saline solution, consisting of 1:200,000 epinephrine (g:g) and 1/3 bupivacain (v:v). We dissected the peritoneum away from the anterior abdominal wall to create a preperitoneal pocket of sufficient size. We spread open a 9 x 9-cm polypropylene mesh in the area, as if we were doing a GPRVS of Stoppa. We followed up our four patients for an average of 32 months. All four cases had an uneventful recovery and were discharged in an average of 3.5 days. They returned to normal daily activity on the 9th day after surgery. We suggest that the preperitoneal mesh repair of a spigelian hernia under local anesthesia is a simple and feasible technique with favorable early and late postoperative results and deserves further investigation in larger series.     

Recurrent Spigelian hernia: a rare cause of colonic obstruction

Spigelian hernia is considered a surgical rarity. Recent articles describe only six recurrent hernias and a scant number of patients with colonic obstruction resulting from incarceration. A patient with intestinal obstruction resulting from recurrent Spigelian hernia with strangulated colon is described. The patient underwent tension-free repair using a prosthetic mesh. Recent literature suggests that the deficiency of connective tissue in patients with hernias justifies the widespread use of permanent mesh for tissue reinforcement and avoidance of recurrences. The rare case presented should be regarded as an illustrative example for application of the tension-free repair principle in the definitive management of recurrent Spigelian hernia. Electronic Publication     

Abdominal wall ectopic testis mimicking spigelian hernia

We encountered a patient with a swelling in the left lateral infraumbilical region and a left undescended testis. The appearance of the swelling was suggestive of a spigelian hernia. At operation, the swelling was actually an abdominal ectopic testis with associated inguinal hernia. This unusual finding led us to report this occurrence and present a brief review of the relevant literature.     

Laparoscopic repair of a spigelian hernia: a case report and literature review.

BACKGROUND: We present a case in which laparoscopy was both diagnostic and therapeutic in a patient with a spigelian hernia. CASE REPORT: A 35-year-old man was referred to the General Surgery Service for evaluation of right lower quadrant abdominal pain of approximately 6 months. The pain was not disabling but was a constant discomfort. The patient did not have any significant past medical or surgical history, and the physical examination was significant only for an area of focal tenderness in the right lower quadrant. Ultrasound and CT scans of the patient's abdomen were unremarkable. A laparoscopic exploration of the area revealed a defect in the area of semilunar and semicircular lines consistent with a spigelian hernia. The patient underwent a laparoscopic herniorrhaphy with placement of a polypropylene mesh. CONCLUSION: This case illustrates the role of laparoscopy in the diagnosis and treatment of spigelian hernias.     

An unusual cause of small bowel obstruction caused by a Richter's-type hernia into the urinary bladder

INTRODUCTION

The authors present an unusual case of small bowel obstruction in a 62-year-old man.

PRESENTATION OF CASE

A 62-year-old man with a background of transitional cell carcinoma (TCC) of the bladder presented to the emergency department with abdominal pain, distension, vomiting and had not opened his bowels for three days. 3 weeks previously he had a repeat Transurtheral resection of bladder tumour (TURBT), during which there was an iatrogenic perforation of the bladder. A CT scan of the abdomen and pelvis revealed small bowel obstruction but did not identify a cause. At laparotomy the cause of the obstruction was identified as a section of the small bowel that had partially herniated into the bladder, via the perforation. The defect was repaired and the patient made an uneventful recovery.

DISCUSSION

Herniation of the bowel into a defect in the bladder wall is a rare event with only 6 previous cases reported in the literature. It can cause signs and symptoms of bowel obstruction.

CONCLUSION

In patients with known bladder perforations who present with symptoms and signs of bowel obstruction, bowel herniation into the bladder should be considered. Early surgical intervention may be necessary if the patient is clinically unwell with appropriate symptoms and signs and imaging does not provide conclusive answer.     

腹腔镜腹腔内补片置入术在半月线疝修补中的应用

目的探讨腹腔镜腹腔内补片置入术行半月线疝修补的临床效果。 方法2010年10月至2016年12月,复旦大学附属中山医院闵行分院在腹腔镜下对11例半月线疝患者进行修补治疗。手术采用超声刀进行疝环周围组织分离后,应用螺旋钉联合补片四角悬吊将防粘补片固定覆盖疝环完成半月线疝修补术。分析总结腹腔镜腹腔内补片置入术行半月线疝修补的临床效果。 结果11例患者均成功地在腹腔镜下行腹腔内补片置入无张力半月线疝修补术。手术时间30～60 min,平均40 min。术中出血10～20 ml,平均15 ml。患者术后排气、排便时间18～30 h,平均25 h。术后住院3～7 d,平均5.5 d。住院期间均未发生感染,无手术副损伤和死亡病例,2例患者发生血清肿。所有患者均获随访,时间6～50个月,未发现复发病例。 结论腹腔镜腹腔内补片置入术修补半月线疝具有创伤小、恢复快、并发症少等优点,符合疝无张力修补原则。     

Incarcerated trocar-wound hernia after laparoscopic hysterectomy

An incarcerated hernia through a 12-mm laparoscopic trocar wound, causing small bowel subobstruction, was diagnosed in a 50-year-old female patient following a laparoscopic hysterectomy 1 month earlier. Trocar-wound hernias causing early postoperative bowel obstruction are very rare. Insertion of trocars at a narrow angle to the abdominal wall may cause larger fascia defects than the actual size of the trocar. Manual examination and closure of large defects, if possible, may prevent such complications.     

Congenital spigelian hernias and cryptorchidism

Purpose

Spigelian hernias in childhood are rare. Only 24 infants in the English literature have been identified to have spigelian hernias, and 12 of these have been associated with cryptorchidism. Spigelian hernias are more commonly seen in the adult population and are considered to be acquired because they are typically associated with trauma or other etiologies of increased intraabdominal pressure. In the infant however, the etiology remains unclear, but a congenital defect in abdominal wall development is suspected.

Methods

We discuss the presentation and treatment of 4 additional patients with spigelian hernias (2 siblings included) associated with cryptorchidism.

Results

The hernias occurred within the well-described spigelian hernia belt in the semilunar line at the level of the semicircular fold of Douglas. Of the 6 repaired spigelian hernias, 5 were closed primarily with absorbable suture similar to previously reported cases; the sixth hernia required a patch closure because of its large size. All cryptorchid testes (7) were repaired in single-stage orchiopexies.

Conclusions

Spigelian hernias are rare entities in infants. We present 4 new cases of spigelian hernias associated with cryptorchidism and, with previously reported cases, discuss the probability of a congenital origin of these hernias in infants.     

Facilitation of open spigelian hernia repair by laparoscopic location of the hernial defect

A spigelian hernia is an uncommon entity. The diagnosis and location of this disorder often is difficult. We present a case in which the hernia could not be located at the time of operation, despite exploration. Laparoscopy performed subsequently enabled location and repair of the hernia under direct visualization, with good results. Laparoscopy is advocated as an adjunct to the diagnosis and treatment of spigelian hernia.     

Incarcerated Spigelian hernia following laparoscopic living-donor nephrectomy.

We present the case of an incarcerated Spigelian hernia that manifested 24 hours after a laparoscopic living-donor nephrectomy. The differential diagnosis, proposed management, and a review of the literature is presented. Bowel obstruction occurring within a few days following laparoscopic surgery is most often attributed to a hernia at a trocar site. In the case of living-donor nephrectomy. the hernia could also occur at the incision made for removal of the kidney. Spigelian hernia has not been reported as a complication of laparoscopic surgery in the past and, therefore, would not normally be considered in the differential diagnosis of any complications following laparoscopic surgery. With the increasing use of laparoscopy, unsuspected intraabdominal conditions may be diagnosed during the procedure or become manifest because of increased intraabdominal pressure created by the pneumoperitoneum. Here we report the diagnosis and repair of a Spigelian hernia that became manifest 1 day after laparoscopic nephrectomy.     

78例老年性腹股沟嵌顿性疝的治疗研究

目的探讨局麻下行无张力疝修补术治疗老年性腹股沟嵌顿性疝的治疗效果。方法对笔者所在医院外科2006年3月～2010年3月收治的老年性腹股沟嵌顿性疝78例患者的临床资料进行同顾性分析。结果78例患者手术全部成功,手术时间40-50min,切口无明显疼痛,术后下床活动时间2～12h,1周恢复正常活动。并发症：伤口硬结3例,阴囊积液1例。随访1—5年无复发病例。结论局麻下行无张力疝修补术治疗老年性腹股沟嵌顿疝是一种安全、有效的术式。     

Obturator hernia repair – a new technique

Obturator hernia is a rare condition with few reports in the world literature. There appears to be no consensus on the ideal approach and repair for such a condition. We report a simple, quick technique via a lower midline incision using an autogenous peritoneal fold. It is ideal for the contaminated case and in settings where mesh is not readily available. Electronic Publication     

Emergency Intraperitoneal Onlay Mesh Repair of Incarcerated Spigelian Hernia

Background and Objectives:

Spigelian hernia is a rare cause of incarcerated ventral abdominal hernia that may pose a diagnostic dilemma. However, with the increasing utilization of double contrast computed tomography (CT) for undiagnosed small bowel obstruction in a virgin abdomen, more such cases are being diagnosed with increasing confidence. Furthermore, with the rapid expansion of the indications for minimal access surgery in emergency situations, these rare emergencies are increasingly tackled using a laparoscopic approach leading to swift patient recovery and discharge.

Methods:

We present the case of an emergency intraperitoneal onlay mesh (IPOM) repair of Spigelian hernia, causing acute small bowel obstruction in a 55-year-old man with liver disease and ascites that was diagnosed using a CT scan. We conducted a search of Medline, Embase, Science Citation Index, Current Contents, PubMed, and the Cochrane Database to review the history of laparoscopic repair of Spigelian hernia and its various advancements, which are briefly presented here.

Results:

The hernia was successfully reduced using laparoscopy, revealing a moderate-size defect in the linea semilunaris. The hernial defect was repaired with a composite mesh that was tacked into position. The patient was discharged from the hospital on the second postoperative day.

Conclusions:

Spigelian hernia in an emergency setting can be easily and swiftly repaired using the IPOM method utilizing a composite mesh.     

Inguinal hernia masquerading as a Spigelian hernia in a child

Inguinal hernia is one of the most common conditions requiring surgical management in childhood. The usual presentation of congenital inguinal hernia in the pediatric age group is an inguino-scrotal swelling. We report a case of inguinal hernia in a child that presented as an abdominal wall swelling clinically suggestive of a Spigelian hernia.     

Intramesosigmoid hernia: a rare type of congenital internal hernia

Intestinal obstruction from congenital internal hernias is a rare and often unsuspected problem. We report the case of a 66-year-old male with a rare type of congenital internal hernia causing bowel obstruction. He underwent successful laparoscopy-assisted surgical repair without bowel resection. Symptomatic congenital internal hernias usually present with intermittent or acute small-bowel obstruction without any history of previous abdominal surgery. Laparoscopy or hand-assisted laparoscopy can be useful tools for locating the region of pathology and enable minimally invasive surgical treatment.