Spigelian hernia associated with strangulation of the small bowel

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A 58-year old female presented to the emergency department with a 48 hour history of right lower quadrant abdominal pain accompanied by nausea, bilious vomiting, abdominal distention and constipation. On admission she was haemodynamically stable. Physical examination revealed a palpable tender, irreducible mass approximately 8 x 6 cm in the right lower quadrant, midway between the umbilicus and the pubis in the mid-clavicular line. Digital rectal examination was normal. Laboratory parameters were within normal limits except mild leukocytosis. CT scan of abdomen showed right sided spigelian hernia with small bowel obstruction. (Figure 1). Emergency surgical exploration revealed spigelian hernia with gangrene of the segment of small bowel (Figure 2) Resection of gangrenous segment of ileum with primary anastomosis was performed. Herniorraphy was performed by closing fascial defect , approximately 3 cm in diameter with interrupted monofilament nonabsorbable suture. Post operative recovery was unremarkable.