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.     

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.     

A laparoscopic approach for incarcerated Spigelian hernia

Incarcerated Spigelian hernia (SH) is an uncommon surgical emergency that demands immediate operative treatment. In the era of minimal access surgery, elective laparoscopic repair of uncomplicated SH is safe and feasible. Herein, we report a case of incarcerated Spigelian hernia that was successfully managed by laparoscopic hernioplasty on an emergent basis.     

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.     

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.     

Case report of ovary and fallopian tube as content of a Spigelian hernia – a rare entity

IntroductionSpigelian hernia is a rare entity, comprising 1–2% of all hernias. Various abdominopelvic viscera herniate through the defect in the Spigelian fascia and become incarcerated. Specifically in females, the ovary and/or the fallopian tube can herniate through this defect. This is the third reported case of such a hernia.Presentation of caseWe report here a young lady aged 30 years with right-sided ovarian Spigelian hernia. She presented with a painful lump in the right lower quadrant of abdomen for 2 weeks. On examination, she had a tender irreducible lump below and to the right lateral to the umblilicus. CECT revealed a right-sided ovarian Spigelian hernia. The finding was confirmed at exploration and herniorrhaphy performed. She was discharged on the 3rd postoperative day.DiscussionDiagnosing Spigelian hernia clinically is challenging but radiologic investigations like computed tomography help establish the diagnosis and clarify the contents.ConclusionSpigelian hernia itself is a rare entity and to add to that, herniation of ovary and fallopian tube through Spigelian fascial defect is very rare and a possibility in females.     

Bladder incarceration in a Spigelian hernia

A patient presented with bladder in an incarcerated Spigelian hernia. Diagnosis was made by clinical examination and ultrasound imaging. Surgical treatment ensured good parietal refection. Such a case has not been previously reported in the literature.     

Spigelian hernias: repair and outcome for 81 patients

Spigelian hernia is a rare partial abdominal wall defect. The frequent lack of physical findings along with vague associated abdominal complaints makes the diagnosis elusive. A retrospective review of Mayo Clinic patients was performed to find all patients who had undergone surgical repair of a Spigelian hernia from 1976 to 1997. Patients were scrutinized for presentation, work-up, therapy, and outcome. The goal of this study was to obtain long-term outcome. The study was set in a tertiary referral center. There were 76 patients in whom 81 Spigelian hernias were repaired. Symptoms most commonly included an intermittent mass (n = 29), pain (n = 20), pain with a mass (n = 22), and bowel obstruction (n = 5). Five patients were asymptomatic. Preoperative imaging was performed in 21 patients and correctly diagnosed the hernia in 15. Spigelian hernias were repaired by primary suture closure (n = 75), mesh (n = 5), and laparoscopic (n = 1) techniques. Eight patients (10%) required emergent operations. Thirteen hernias (17%) were found to be incarcerated at the time of the operation. Overall mean follow-up for the 76 patients was 8 years, with three hernia recurrences identified. Spigelian hernia is rare and requires a high index of suspicion given the lack of consistent symptoms and signs. An astute physician may couple a proper history and physical examination with preoperative imaging to secure the diagnosis. Mesh and laparoscopic repairs are viable alternatives to the durable results of standard primary closure. Given the high rate of incarceration/strangulation, the diagnosis of Spigelian hernia is an indication for surgical repair.     

Update on Spigelian Hernia: Diagnosis and Treatment by Means of Two Cases

The rarity of Spigelian hernias and the frequent subtle clinical findings can cause an important delay in diagnosis, especially in obese patients. Furthermore it has a high risk of incarceration. When this occurs, a fast recognition and adequate treatment are necessary. Treatment can be primary suture or mesh repair. More recently, the laparoscopic approach has become more popular. We present two cases of incarcerated Spigelian hernia and we give a review of the literature, with specific attention for the anatomical features and pathogenesis.     

Update on Spigelian hernia: diagnosis and treatment by means of two cases

The rarity of Spigelian hernias and the frequent subtle clinical findings can cause an important delay in diagnosis, especially in obese patients. Furthermore it has a high risk of incarceration. When this occurs, a fast recognition and adequate treatment are necessary. Treatment can be primary suture or mesh repair. More recently, the laparoscopic approach has become more popular. We present two cases of incarcerated Spigelian hernia and we give a review of the literature, with specific attention for the anatomical features and pathogenesis.     

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.     

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.     

Bilateral Spigelian hernia treated by two‐layered prolene mesh

Spigelian hernia is an uncommon variety of abdominal hernias. It has been traditionally treated by tension‐free mesh hernioplasty. We report a rare case of a bilateral Spigelian hernia in an elderly male that was treated by bilateral two‐layeyed prolene mesh hernia system. Rare ventral hernia such as Spigelian hernia with weak abdominal wall can be safely treated by tension‐free mesh repair using bilayered prolene mesh system.     

Appendicitis in abdominal wall hernia: Case series and literature review

Appendicitis in hernia is a rare disease entity. It usually presents with symptoms and signs of incarcerated hernia, and accurate preoperative diagnosis is difficult. Management includes appendicectomy and hernia repair. Different approaches of appendicectomy have been proposed, including transherniotomy, transabdominal and laparoscopic routes. In this case series, three cases of appendicitis inside different types of abdominal wall hernias, namely incisional, inguinal and Spigelian, are described. A literature review was also performed. Scientific evidence is lacking, and the optimal management remains to be defined.     

Right lower quadrant abdominal pain due to appendicitis and an incarcerated spigelian hernia

Spigelian hernias are uncommon and difficult to diagnose because of their location in the aponeurosis in the anterior abdominal wall. When they occur on the right side, the symptoms can include nonspecific abdominal pain mimicking appendicitis. We present an adult with right lower quadrant abdominal pain due to an incarcerated spigelian hernia and acute appendicitis. Early recognition and prompt surgical treatment were important to the successful treatment of our patient.     

Spigelian hernia: 3 case reports

Spigelian hernia is an uncommon hernia of the abdominal wall, often not easily diagnosed. Three cases of Spigelian hernia are reported. In the first patient it was an incidental discovery, in the second one hernia was complicated by strangulation of the small bowel, in the third patient hernia was symptomatic without complications. In all the patients, in their previous clinical history, an operation for hernia or other abdominal pathologies was observed. These patients were treated surgically, using direct reconstruction of the abdominal wall in two cases, while a non-absorbable mesh was positioned in the preperitoneal space in the third patient. The anatomopathological and clinical features of Spigelian hernia are described and the problems in diagnosis discussed; in addition, the importance of surgical cure in incidental hernia is underlined.     

Concomitant Spigelian and inguinal hernias in a neonate

A Spigelian hernia presented concurrently with bilateral inguinal hernias in a 1-month-old infant. This case emphasizes that a Spigelian hernia can occur in neonates and synchronously with an inguinal hernia. Analysis suggests that a Spigelian hernia, regardless of age of presentation, is congenital in origin.     

Minimally Invasive Spigelian Hernia Repair

Introduction:

Spigelian hernia is an uncommon ventral hernia characterized by a defect in the linea semilunaris. Repair of spigelian hernia has traditionally been accomplished via an open transverse incision and primary repair. The purpose of this article is to present 2 case reports of incarcerated spigelian hernia that were successfully repaired laparoscopically using Gortex mesh and to present a review of the literature regarding laparoscopic repair of spigelian hernias.

Methods:

Retrospective chart review and Medline literature search.

Results:

Two patients underwent laparoscopic mesh repair of incarcerated spigelian hernias. Both were started on a regular diet on postoperative day 1 and discharged on postoperative days 2 and 3. One patient developed a seroma that resolved without intervention. There was complete resolution of preoperative symptoms at the 12-month follow-up.

Conclusion:

Minimally invasive repair of spigelian hernias is an alternative to the traditional open surgical technique. Further studies are needed to directly compare the open and the laparoscopic repair.     

Planned totally extraperitoneal laparoscopic Spigelian hernia repair

A Spigelian hernia is a congenital defect in the tranversus aponeurosis fascia. Traditionally, an open anterior hernioplasty was used to repair these defects. Recently, laparoscopic approaches have been described. This report describes the first application of the totally extraperitoneal laparoscopic approach to a planned repair of a Spigelian hernia. The patient was a 62-year-old white female with a reducible left lower quadrant anterior abdominal wall bulge consistent with a Spigelian hernia. At the time of surgery, we exposed the posterior rectus fascia and modified our extraperitoneal inguinal hernia technique by passing the balloon dissector in a more lateral orientation. This created a unilateral preperitoneal space with adequate room for dissection and mesh fixation. The Spigelian defect was easily identified. Its preperitoneal fat contents were reduced, and a 5-mm laparoscopic tacking device was used to secure a piece of prolene mesh. The patient was discharged home with no complications. Placement of the mesh in the preperitoneal space avoids direct interaction of the mesh prosthesis and the intraperitoneal viscera. In conclusion, we find that a laparoscopic totally extraperitoneal approach is technically feasible and advantageous when a Spigelian hernia is diagnosed preoperatively.     

Spigelian hernia: an up-to-date

Nine cases of Spigelian hernia occurred and surgically treated in the years 1992-1997 are reported. Spigelian hernias were observed in 5 females and 3 males with mean age of 62.1 years (range 49-70). In 5 cases prosthetic repair has been done with preperitoneal mesh and a very good outcome. In a 61 years old obese female spigelian hernia was bilateral. Her left sided hernia needed an emergency operation for strangulation. Hernia has been repaired by simple suture and recurred early. For the diagnosis of Spigelian hernia it is essential to remember it inside the "Spigelian belt". The satisfactory results obtained at present by prosthetic repair are underlined.