Abstract
IntroductionLower Spigelian hernia is a very rare entity. The clinical findings are similar to those of inguinal hernias and in many cases may be misdiagnosed. In the literature, only a few references to this entity have been reported in children. To the best of our knowledge, this is the first case report of a lower Spigelian hernia in a child who presented with an acute painful scrotum.Case presentationWe discuss the case of a 6-year-old Greek boy who presented to our emergency department complaining of severe pain in the left inguinal area and scrotum. The acute painful swelling started suddenly, without any obvious cause. The initial diagnosis was incarcerated inguinal hernia which was reduced with difficulty. Five days later, the patient still experienced mild pain during palpation and he was operated on. During the operation, a large lower Spigelian hernia was revealed and reconstructed.ConclusionAlthough Spigelian hernias are rare in children and difficult to diagnose, physicians should be aware of them and include them in the differential diagnosis.
Highlights
Lower Spigelian hernia is a very rare entity
Spigelian hernias are rare in children and difficult to diagnose, physicians should be aware of them and include them in the differential diagnosis
We report a rare case of a lower Spigelian hernia in a child which presented as an incarcerated inguinal hernia
Summary
Lower Spigelian hernia is a rare entity in pediatric surgery, and is often misdiagnosed as an inguinal hernia [1]. Less than 50 cases have been presented in the literature, and only half of them occurred in younger children In most of these cases, Spigelian hernias are considered congenital, there is not enough evidence to support this suggestion [2,3]. We report a rare case of a lower Spigelian hernia in a child which presented as an incarcerated inguinal hernia. The child presented with mild discomfort and pain in the left testicle without clinical evidence of testicular torsion. These symptoms persisted for 3 days and we decided to operate on the patient. Spigelian hernias usually present just lateral to the rectus muscle in the lower left quadrant. Eight years after the operation, the patient remains free of symptoms and recurrence
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