Diagnosis Of Spigelian Hernia Research Articles

Spigelian Hernia and Appendicitis: A Rare Case Report

Introduction: Hernias containing the appendix are well-known entities that preferentially affect the groin. The presence of an appendix within a Spigelian hernia, which is a rare ventral hernia that presents with nonspecific symptoms and location, adds significantly to the complexity and rarity of its diagnosis. Further, only 18 such cases were reported and published in the literature. We report a case of Spigelian hernia and appendicitis within the hernial sac to highlight the diagnostic challenges associated with this type of hernia. Case Presentation: In her late 30s, a female who underwent laparoscopic surgery for a uterine fibroid two and a half years back presented with right lower quadrant abdominal pain for two days. This followed abdominal pain on exertion for the previous nine months. On examination, there was tenderness, guarding, and a positive cough impulse in the right lower quadrant of the abdomen. Her body mass index was 37.53 kg/m2. A contrast-enhanced computed tomography imaging of the abdomen reported a right iliac fossa incisional hernia with omental congestion necessitating an emergency laparoscopic surgery. At surgery, a Spigelian hernia, which was at least 5 cm away from the port site scar of the previous surgery, was found. The hernia contained an inflamed appendix. Thus, a diagnosis of Spigelian hernia and appendicitis within the hernial sac was made. A laparoscopic reduction and repair of the Spigelian hernia and a laparoscopic appendectomy were performed. Conclusion: Whereas Spigelian hernias are considerably rare, the presence of an appendix within a Spigelian hernia sac is yet a more infrequent occurrence. Although the imaging modalities are often inconclusive, careful interpretation of the computed tomography imaging findings may reveal the pathology preoperatively.

Spigelian hernia - an unusual abdominal hernia: a case report and review of literature

Spigelian hernias are rare abdominal wall defects that occur at the semilunar line lateral to the rectus abdominis muscle. They are situated between the muscular layers of the abdominal wall and can be easily overlooked because of abdominal obesity. Generally difficult to diagnose because of their location and vague non-specific symptoms radiographic studies have been beneficial in confirming the diagnosis. The diagnosis has been considerably aided by the introduction of ultrasonography and Computed Tomography (CT). Once the diagnosis is made operative management is indicated due to chances of incarceration. We report a 48 years old patient from the IMS and SUM hospital, Bhubaneswar, Odisha, India who presented with colicky lower abdominal pain associated with a non-tender swelling above and lateral to the left inguinal canal. A diagnosis of Spigelian hernia was made and confirmed on exploration. The hernia was reduced and the defect repaired. His recovery was uneventful.

Small Bowel Herniation Through a Spigelian Defect Within 48 Hours After Laparoscopy

Spigelian hernia is extremely rare, with an incidence of 1% to 2% of all abdominal hernias. Herein we report the case of a woman with a spigelian hernia occurring within 48 hours after laparoscopic salpingo-oophorectomy. The patient had abdominal pain, nausea, and abdominal mass. An abdominal series revealed multiple dilatations of the small bowel, compatible with a small bowel obstruction, and computed tomography demonstrated a right-sided abdominal hernia with small bowel obstruction. The diagnosis of spigelian hernia was made during a second surgery. The bowel was reduced and the fascial defect repaired. The postoperative recovery was uneventful. It would seem that pneumoperitoneum during laparoscopic surgery and the trauma of trocar insertion can trigger development of a spigelian hernia.

Radiological and clinical examination in the diagnosis of Spigelian hernias

IntroductionSpigelian hernia are rarely reported lateral abdominal wall hernias. Clinical diagnosis of a suspected hernia can be challenging owing to vague presenting symptoms and signs. This study aimed to investigate the accuracy of preoperative imaging and clinical examination in the diagnosis of Spigelian hernias.MethodsA retrospective analysis was performed of patients who presented to North Tyneside and Wansbeck General Hospitals between 1998 and 2010. All patients were assessed by a consultant general surgeon in the outpatient clinic or on the surgical admissions ward. Patients were included who presented with a history suggestive of a Spigelian hernia and a palpable lump or equivocal clinical examination. All patients proceeded to surgery, which was used as the reference standard.ResultsOverall, correlation with operative findings showed computed tomography (CT) to have a sensitivity of 100% and a positive predictive value (PPV) of 100%. Ultrasonography had a sensitivity of 90% and a PPV of 100%. Clinical assessment alone had a sensitivity of 100% and a PPV of 36%.ConclusionsThis study shows that ultrasonography and CT have a high sensitivity and PPV in relation to occult Spigelian hernias. When no obvious Spigelian hernia is present, patients should be evaluated with radiological investigation to establish a diagnosis. Owing to diagnostic uncertainty, a laparoscopic approach should be favoured.

Left Lower Quadrant Abdominal Mass: A Case of Spigelian Hernia Diagnosed by Emergency Ultrasound

Spigelian hernia is rare. The diagnosis of Spigelian hernia is often challenging. We report a case of Spigelian hernia in which emergency ultrasonography diagnosed correctly a Spigelian hernia, which was later confirmed by computed tomography and at surgery. In our opinion, ultrasonography can be an important tool for emergency physicians in cases of abdominal pain or abdominal mass.

Herniography (Peritoneography) for Diagnosis of Spigelian Hernia

Spigelian hernia is a rare clinical condition. It is difficult to diagnose in absence of obvious clinical signs. Ultrasound scan, cross-sectional imaging and contrast studies like herniography have been widely used for detecting occult abdominal wall hernias in symptomatic patients. We present our experience of detecting a clinically occult Spigelian hernia in a 56-year-old symptomatic male patient, who had concomitant left sided inguinal and Spigelian hernias. In this patient, the Spigelian hernia was not detected on ultrasound scan. We also present a review of literature on the role of herniography in the diagnosis of this rare condition. Herniography is a sensitive investigation for evaluation of occult hernias. However, it is an invasive contrast study and therefore must be used selectively. Non-invasive real-time imaging like ultrasonography remains the first line of investigation for detecting occult hernias.

Spigelian hernias: repair and outcome for 81 patients.

Spigelian hernia is a rare partial abdominal wall defect. The frequent lack of physical findings along with vague associated abdominal complaints makes the diagnosis elusive. A retrospective review of Mayo Clinic patients was performed to find all patients who had undergone surgical repair of a Spigelian hernia from 1976 to 1997. Patients were scrutinized for presentation, work-up, therapy, and outcome. The goal of this study was to obtain long-term outcome. The study was set in a tertiary referral center. There were 76 patients in whom 81 Spigelian hernias were repaired. Symptoms most commonly included an intermittent mass (n = 29), pain (n = 20), pain with a mass (n = 22), and bowel obstruction (n = 5). Five patients were asymptomatic. Preoperative imaging was performed in 21 patients and correctly diagnosed the hernia in 15. Spigelian hernias were repaired by primary suture closure (n = 75), mesh (n = 5), and laparoscopic (n = 1) techniques. Eight patients (10%) required emergent operations. Thirteen hernias (17%) were found to be incarcerated at the time of the operation. Overall mean follow-up for the 76 patients was 8 years, with three hernia recurrences identified. Spigelian hernia is rare and requires a high index of suspicion given the lack of consistent symptoms and signs. An astute physician may couple a proper history and physical examination with preoperative imaging to secure the diagnosis. Mesh and laparoscopic repairs are viable alternatives to the durable results of standard primary closure. Given the high rate of incarceration/strangulation, the diagnosis of Spigelian hernia is an indication for surgical repair.

Spigelian hernia: diagnosis by high-resolution real-time sonography.

The purpose of this study was to demonstrate the role of high-resolution real-time sonography in the diagnosis of spigelian hernias. The sonographic findings in three patients, two of whom had surgical confirmation, are presented. We also discuss and demonstrate the anatomic and pathologic factors that predispose to these hernias. In all three cases, real-time high-resolution sonography was very helpful in providing detailed images of the abdominal wall defect, the hernial sac and contents, and the relationship of the contents to the spigelian fascia and the rectus, external oblique, and internal oblique muscles. The role of the Valsalva and other provocative maneuvers in demonstrating the "in and out" sliding movement of the contents of the hernia also is discussed. Although the number of cases in our study is small, we think that this modality may be the most effective means for establishing this diagnosis, especially in cases with equivocal clinical findings.

Laparoscopic diagnosis and repair of spigelian hernia: Report of a case and technique

Spigelian hernia is an uncommon hernia of the abdominal wall. We report a case of acquired spigelian hernia diagnosed and treated by laparoscopy. With more extensive use of laparoscopy to evaluate abdominal pain, the diagnosis of spigelian hernia can be made and repair accomplished without need for open exploratory surgery.