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.     

Pediatric Spigelian hernia: A case report

Report of a Spigelian hernia in a 13 yr old girl. The condition may well be more common than generally believed, and the diagnosis should be considered in all children with intermittent abdominal pain, even in the absence of a palpable mass.     

Laparoscopic diagnosis and repair of Spigelian hernia: A case report and literature review

IntroductionSpigelian hernias are a rare type of hernia which protrude through the abdominal wall at the semilunar line. They are especially difficult to diagnose due to their location and non-specific symptoms and are often overlooked because of their positioning between muscular layers. Patients may present with localized pain which can aid the diagnosis. CT and ultrasound are also helpful.Presentation of case: We present the case of a 75-year-old female patient who presented to Hialeah Hospital with a one-year history of abdominal pain localized to the left lower quadrant.DiscussionA Spigelian hernia containing omentum, was found during a diagnostic laparoscopy. The hernia was reduced, and the abdominal defect was repaired via primary repair, reinforced by mesh. The patient recovered uneventfully.ConclusionNonspecific physical exam findings and inconclusive imaging studies represented a diagnostic challenge. Here we discuss a case of a Spigelian hernia discovered through diagnostic laparoscopy.     

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.     

Appendicular abscess with appendicolith in a Spigelian hernia masquerading caecal volvulus-A case report

INTRODUCTIONSpigelian hernias are rare hernias of the anterior abdominal wall named after Adrian van den Spiegel, the anatomist who first described them in the 16th century. They represent around 2% of all hernias.PRESENTATION OF CASEWe present an 83-year-old female with one week history of a painful right iliac fossa swelling, her examination revealed a tender lump with no cough impulse and non-reducible and her computed tomography (CT) scan showed a mass anterior to ileocaecal valve suggestive of a caecal volvulus. Intra-operative the finding was a Spigelian hernia containing an appendicular abscess and an appendicolith.DISCUSSIONThe diagnosis of Spigelian hernias represents a challenge for the surgeons principally due to their rarity but also due to their anatomy and the variety of their contents. Searching the literature we found many different intra-abdominal structures presenting within a Spigelian hernia but we did not encounter a case similar to this.CONCLUSIONClinicians need to be aware of these hernias when dealing with lower abdominal swellings and have a high index of suspicion even in the presence of negative clinical and CT findings.     

Spigelian hernia in children: low versus classical

Purpose

Pediatric spigelian hernias are very rare. They are often missed or misdiagnosed. A series of cases with spigelian hernia, presented to a tertiary care center are presented here with emphasis on different anatomy of spigelian hernias with cryptorchidism and those without associated cryptorchidism.

Laparoscopic totally extra-peritoneal hernia repair for bilateral Spigelian hernias and coincident inguinal hernia: A case report

IntroductionSpigelian hernia (SH) is a rare ventral hernia occurring near the lateral border of the rectus muscle. The treatment remains controversial and depends on institutional expertise. Although laparoscopic surgery is a good adaptation for the repair of ventral hernias, only a few cases have been reported in the literature. Here, we report a case of totally extra-peritoneal (TEP) repair for bilateral SHs.Presentation of caseA 74-year-old Japanese man presented with asymptomatic bulges in the right lower abdominal quadrant. On physical examination, the bulges were located to the right of the lateral border of the abdominal rectus muscle and the right inguinal region in an upright position. We diagnosed right SH and coincident homonymous ipsilateral inguinal hernia (IH) by abdominal computed tomography and planned a curative operation by laparoscopy. By first laparoscopic exploration, we found an asymptomatic SH to the left of the lateral border of the abdominal rectus muscle and performed TEP repair for all hernias. The second laparoscopic exploration after fixing the mesh in place revealed that the orifice of the right SH was scarred and stiffened by repeated prolapse. We finally eliminated the sac by ligation because of a fear causing of reduction en masse of the SH.Discussion and conclusionThe use of laparoscopy simplified the diagnosis and facilitates the subsequent repair of the hernia. TEP approach is the ideal treatment for the simultaneous laparoscopic repair of SH and IH.     

Richter's hernia through a Spigelian defect of the abdominal wall

A 78-year-old healthy woman with no previous surgeries or history of trauma presented with a painful abdominal mass for 1 day. The computed tomography (CT) scan of the abdomen demonstrated a partial herniation and strangulation of the cecum (Richter's hernia) between the internal and external oblique muscles through the linea semilunaris (Spigelian hernia). The challenging clinical diagnosis of Spigelian hernias and their surgical treatment options are discussed.     

Spigelian hernia: bibliographical study and presentation of a series of 28 patients

Abstract. Spigelian hernias are rare defects of the abdominal wall. Our aim is to analyse the bibliography and present a series of 28 patients. A Medline bibliographical study was performed between 1970 and 2000 with analysis of the number of cases, series, ratio of cases to year and type of journal. We also present a personal study and analyse epidemiological, diagnostic, and treatment factors. There are 159 articles, 479 cases, and 19 series of more than five patients published in 85 journals (42.3% medical). Our diagnosis was preoperative in 75%, and programmed surgery was 3.6 times more common than emergency surgery. We found a significant relationship between hospital stay and type of surgery (P<0.02) and surgical technique used (P<0.001). We found that spigelian hernias have a multidisciplinary interest; they are given almost equal treatment in medical and surgical journals; preoperative diagnosis can be established in 75% of cases; and the best results are offered by the extraperitoneal laparoscopic approach. Electronic Publication     

Spigelian hernia presenting as an incarcerated incisional hernia

Summary Spigelian hernia, first described at the 18th century, is a rare ventral abdominal hernia occuring through the spigelian fascia. The diagnosis is difficult especially when there is no palpable mass. The case presented here had a spigelian hernia mimicking an incarcerated incisional hernia. This patient had undergone an appendectomy through a right paramedian incision proviously. Three years later she was operated for a suspected incisional hernia. Exploration did not reveal any defects in the external oblique aponeurosis so no further exploration was done. Our operative findings showed also an intact external oblique aponeurosis but when incised a spigelian hernia was observed beneath this structure, which was repaired promptly. A high index of suspicision is necessary for diagnosis both pre and intraoperatively.     

A strangulated Spigelian hernia mimicking diverticulitis

Summary Spigelian hernias are true interparietal hernias that are frequently not associated with a palpable mass and, as such, are not frequently diagnosed before surgery. Reported herein, is the serendipitous discovery of an incarcerated Spigelian hernia that was discovered on a CT scan being performed for presumed diverticulitis.     

Spigelian hernia: a case report and review of the literature

Spigelian hernia is a rare abdominal hernia that occurs through Spigelian aponeurosis. The Authors present a case of Spigelian hernia associated with narrowing of sigmoid colon and diverticular pathology. They also described historical background, surgical anatomy and etiopathogenesis of this hernia. By a remarkable revision of literature, they sum up epidemiology and clinical features of Spigelian hernia. Furthermore, they discuss diagnostic and therapeutic principles.     

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     

An unusual presentation of an incarcerated Spigelian hernia

Spigelian hernias are rare hernias, occurring through a defect in the Spigelian aponeurosis. Like other hernias, they may contain abdominal contents but are more likely to be incarcerated due to the small size of the fascial defect. Multiple intra-abdominal organs have reportedly been found in Spigelian hernias. A search of the literature showed only nine reported cases in which an appendix has been found within a Spigelian hernia. We present a patient with a history of lower abdominal pain since 10 weeks with a large intra-abdominal mass in the right iliac fossa. Due to abscess formation with spontaneous evacuation through the abdominal wall, drainage and incision were performed and the patient was treated with broad-spectrum antibiotics. An explorative laparoscopy after six weeks showed an incarcerated appendix in a Spigelian hernia.     

Concurrent Spigelian hernia and falciform ligament hernia in a 67-year-old female

IntroductionInternal abdominal hernias account for 1% of all hernias but 5.8% of all bowel obstructions and hence are of significant clinical importance. Similarly Spigelian hernias account for only 0.12–2% of all abdominal wall hernias.Case presentationWe present and discuss the management of a case that presented with concurrent falciform ligament internal abdominal hernia and Spigelian hernia. We believe this is the first reported case of such an occurrence in the literature.ConclusionDue to the advancements in computer topography (CT) imaging many internal and Spigelian hernias are diagnosed pre-operatively though these scan are not always available or indicated in cases of suspected small bowel obstruction. Due to the high mortality rate of undiagnosed internal hernias a high clinical suspicion must be maintained. The authors recommend laparoscopic trans-abdominal repair of Spigelian hernias in order to examine the abdominal contents and exclude rare, though potentially serious internal hernias.     

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.     

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.     

Parapubic hernia: case report and review of the literature

Parapubic hernia is considered rare, with 18 hernias described in five articles published since 1971. The hernia results from iatrogenically or traumatically detached rectus abdominis muscles at the pubic bone and presents a therapeutic challenge because there is no strong aponeurotic anchoring structure in the defect's caudal aspect. We describe a patient with a large parapubic hernia repaired by a combined preperitoneal and onlay prosthetic method. This report adds another dimension to the prosthetic repair options in parapubic hernias and illustrates the effectiveness of the tension-free repair principle in their definitive management. Electronic Publication