Spigelian hernia: An unusual presentation of an uncommon entity

Introduction

Spigelian hernia (SH) is an uncommon defect of the abdominal wall that occurs through the spigelian fascia. SH has varied, non-specific, dubious clinical features which makes diagnosis extremely difficult at times. Pain is common and is invariably associated with the narrow neck of the sac; atypically, our patient had no history of pain at any time.

Case Report

Herein, we present the case of an extremely rare variety of hernia in an 83-year-old male patient. Clinical examination revealed globular, subcutaneous, soft, reducible swelling measuring 6 × 8 cm over the left iliac fossa of this patient with visible cough impulse. Ultrasonography (USG) showed a 2.5 × 2.5 cm muscle defect in the anterior abdominal wall above and lateral to the left inguinal region.

Discussion

SH is a rare form of ventral hernia. The commonest presenting feature is pain, or an anterior abdominal wall lump or incarceration. Real-time USG can easily detect the defect and demonstrate the cough impulse. Both open and laparoscopic approaches have been elected for repair.

Conclusion

Radiological investigations must be undertaken, and surgery should always be performed to avoid risk of strangulation or incarceration of the hernia. Although laparoscopic repair has gained popularity, the open approach remains the gold standard in emergency situations.