Abstract
BackgroundGastrointestinal cancer, gynecologic cancer and malignant peritoneal mesothelioma may disseminate widely to the surfaces of the abdomen and pelvis. In some patients this spread of the disease may find its way into a hernia sac. MethodsThe Spigelian hernia is caused by a protrusion of the peritoneum of the anterior abdominal wall into the abdominal wall muscle. This peritoneal defect occurs through the semilunar line of Spiegel in or closely associated with the semicircular line of Douglas. ResultsA patient presented with a large (11 cm greatest diameter) mass in the left lower quadrant. The mass was composed of malignant peritoneal mesothelioma and was anatomically located within the Spigelian hernia belt. At the time of cytoreductive surgery numerous other sites of malignant peritoneal mesothelioma were present within the abdomen and pelvis. ConclusionsThe left lower quadrant mass was a malignant peritoneal mesothelioma presenting within a Spigelian hernia defect. This phenomenon has not been previously reported.
Highlights
When cancer disseminates within the abdominal and pelvic space as peritoneal metastases, it does so by a definite pattern that is characteristic of a particular cancer diagnosis [1]
The presenting sign of malignant peritoneal mesothelioma in a Spigelian hernia has not been previously reported. In this case report a 70-year-old woman presented with an abdominal wall mass of malignant peritoneal mesothelioma at the exact site where a Spigelian hernia would case a bulge
There are several reports in the oncology literature regarding peritoneal metastases becoming symptomatic within a hernia sac
Summary
Gastrointestinal cancer, gynecologic cancer and malignant peritoneal mesothelioma may disseminate widely to the surfaces of the abdomen and pelvis. In some patients this spread of the disease may find its way into a hernia sac. METHODS: The Spigelian hernia is caused by a protrusion of the peritoneum of the anterior abdominal wall into the abdominal wall muscle This peritoneal defect occurs through the semilunar line of Spiegel in or closely associated with the semicircular line of Douglas. CONCLUSIONS: The left lower quadrant mass was a malignant peritoneal mesothelioma presenting within a Spigelian hernia defect. This phenomenon has not been previously reported
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