Spigelian hernias: anatomy and roentgenographic manifestations.

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The anatomy of an uncommon but important type of lateral ventral hernia is reviewed. The key radiographic findings are air or contrast filled bowel seen laterally outside the confines of the peritoneal cavity, the “beak sign” of hernia, the sharp constriction of the proximal herniated loop, and the intermittent nature of the hernia. The setting in which to consider this diagnosis—acute bowel obstruction, intermittent abdominal pain, and “vanishing masses”—is discussed. The alert radiologist can suggest this diagnosis in cases in which the lesion is not found or appreciated by the clinician.