Spigelian hernia in gynaecology

Anastasia Ussia,Arnaud Wattiez,Larissa Schindler,Philippe R Koninckx,Fabio Imperato

doi:10.1186/s10397-017-1010-8

Anastasia Ussia, Arnaud Wattiez + Show 3 more

Open Access

https://doi.org/10.1186/s10397-017-1010-8

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Journal: Gynecological Surgery	Publication Date: May 15, 2017
Citations: 4	License type: open-access

Affiliation: Latifa Hospital, KU Leuven

Abstract

BackgroundA Spigelian hernia is a rare hernia through the Spigelian fascia between the rectus muscle and the semilunar line. This hernia is well known in surgery. Symptoms vary from insidious to localised pain, an intermittent mass and/or a bowel obstruction.ResultsThe Spigelian hernia is poorly known in gynaecology. Spigelian hernias may be causally related to secondary trocar insertion. This review is written to increase awareness in gynaecology and is illustrated by a case report in which the diagnosis was missed for 4 years even by laparoscopy. Smaller hernias risk not to be diagnosed and will thus not be treated. Even larger Spigelian hernias might not be recognised and treated appropriately.ConclusionsThe gynaecologist should consider a Spigelian hernia in women with localised pain in the abdominal wall lateral of the rectus muscle some 5 cm below the umbilicus. Smaller hernias can be closed by laparoscopy without a mesh. Larger hernias require a mesh repair.

Highlights

A Spigelian hernia is a rare hernia through the Spigelian fascia between the rectus muscle and the semilunar line
Symptoms of a Spigelian hernia Spigelian hernias can present as acute small bowel obstructions [15, 21] even of the colon [22]
Diagnosis of a Spigelian hernia According to the surgical literature, dealing with larger and symptomatic hernias, the diagnosis is based on clinical examination helped by ultrasound or computed tomography [16]

Summary

Introduction

A Spigelian hernia is a rare hernia through the Spigelian fascia between the rectus muscle and the semilunar line. This hernia is well known in surgery. Symptoms vary from insidious to localised pain, an intermittent mass and/or a bowel obstruction. The Spigelian fascia is the aponeurotic layer between the rectus abdominis muscle medially and the semilunar line laterally. This hernia can present as a localised pain, as an intermittent mass or as a bowel obstruction [2]. Spigelian hernia carries a risk of bowel incarceration and should be repaired [3]. For smaller Spigelian hernias, a mesh-free laparoscopic suture repair is feasible [4, 5]

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