Spigelian Hernia Research Articles

Adriaan van den Spiegel (1578-1625): anatomist, physician, and botanist.

Adriaan van den Spiegel (1578-1625) was a Flemish anatomist and physician. He was one of the most prominent anatomists at the University of Padua during the 17th century and became professor of anatomy and surgery there in 1619. He was privileged to have two of the most accomplished anatomists of that period, Fabricius ab Aquapendente and Iulius Casserius, as his teachers. His anatomical works were published after his death by his pupil Bucretius and his son-in-law Liberalis Crema, with illustrations procured from Casserius's unpublished anatomical atlas. He contributed significantly to establishing basic morphological facts about the developing embryo in his text De formato foetu liber singularis. In his book De humani corporis fabrica libri decem, Spiegel's lobe (caudate lobe) of the liver and the linea semilunaris (Spiegel's line) on the lateral side of the rectus abdominis muscle were described for the first time. Subsequently, Spigelian aponeurosis (between the lateral margin of the rectus abdominis and the linea semilunaris) and Spigelian hernia (lateral ventral hernia) were named after him. He was a renowned physician in his time and was the first to give a detailed description of malaria. He made significant contributions as a botanist: the genus Spigelia, which has six species, is named after him.

Spigelian hernia: a diagnostic dilemma and laparoscopic management.

Spigelian hernias, also called as lateral ventral hernias, are rare hernias to present themselves in clinical practice. The significance of these hernias lies in the fact that they are commonly intraparietal hernias and are, hence, difficult to diagnose clinically. Moreover, the neck of these hernias is usually small, posing a fair risk of strangulation. With the advancement in laparoscopic hernia repair, there is evidence that Spigelian hernias too can be repaired laparoscopically, thereby causing less morbidity and shorter hospital stay. Here, we present a rare case of large Spigelian hernia that posed to us as a diagnostic dilemma. The symptoms, clinical findings, and ultrasound of the patient were not specific, and a CT scan had to be used as the measure to confirm the diagnosis. The patient was then managed successfully with laparoscopic intraperitoneal onlay mesh repair. The details of the case and a brief discussion are included.

Spigelian hernia showing itself as a left lower abdominal mass

Summary Spigelian hernia is a rare type of hernia. It can be congenital or acquired. Patients usually have a painful mass in the mid-to-lower abdomen, which is sometimes reducible in the supine position. Because of its high rate of incarceration, surgery should be performed as soon as a Spigelian hernia is diagnosed. We report a male patient with a palpable mass in his left lower abdomen; Spigelian hernia was diagnosed by means of ultrasound and computed tomography (CT). He underwent surgery soon after the diagnosis was made. The hernia defect was closed by interrupted nonabsorbable sutures without a mesh. He was discharged a few days later and recovered uneventfully.

English

INTRODUCTION: Spigelian hernia is named after Belgian anatomist Adriaen van den spigehel who described the semilunar line (linea spigeli). However it was first described and defined after Josef Klinkosch in 17641 spigelian hernia is protrusion of preperitoneal fat, peritoneal sac, or viscera through a congenital or acquired defect in spigelian aponeurosis. Frequently presents between 50-70 years of age, male: female ratio is 1:1.18 & occurs twice as often as on right side compared to left side. Reported incarceration case is 17%, with acute presentation in 10%& lack of physical findings in 36%.2 They are uncommon and only about 1000 cases have been reported in the literature.3 This case is being reported because of its rarity. These are the hernias representing 1%-2% of all abdominal hernias. Accurate prospective diagnosis of this condition is difficult because of the physical presence of these hernias is often not demonstrable owing to its peculiar anatomic location. Many patients of spigelian hernia therefore may have no obvious findings on clinical examination. The diagnosis is even more difficult in obese people where in the hernial sac may lie in an intraparietal plane masked by abdominal subcutaneous fat3.

Totally Extraperitoneal Single Incision Laparoscopic Repair of Spigelian Hernia: Technical Notes

Abstract Spigelian hernia is an intraparietal hernia of the anterior abdominal wall occurring through the spigelian aponeurosis that accounts for 2% of all abdominal wall hernias. Traditionally, sp...

Bilateral spigelian hernias: Diagnosis and treatment in a regional hospital

Bilateral spigelian hernias: Diagnosis and treatment in a regional hospital

Hernies de Spiegel

Spigelian hernias represent 1-2% of all abdominal wall hernias. The pathogenesis often involves a dehiscence of the transverse and internal oblique muscle aponeurosis. The diagnosis is made by physical examination; but sometimes it is complicated by obesity. The risk of strangulation is important and can reach 30%. The abdominal CT scan is helpful in the description of hernia's topography and sometimes in diagnostic confirmation. The treatment is surgical. The rate of recurrence after direct closure is considerable. Synthetic mesh repair seems to be a more adequate alternative. The advent of laparoscopy has improved the management of these hernias.

Laparoscopic Transabdominal Preperitoneal Repair of Spigelian Hernia—Closure of the Fascial Defect Is Not Necessary

Spigelian hernia (SH) is rare and is traditionally repaired using an open technique. There has been an increasing popularity of laparoscopic methods, with transabdominal preperitoneal (TAPP) repair being one of the popular techniques. Currently, most surgeons using the TAPP technique close the fascial defect prior to mesh placement. Here we report our experience with a TAPP repair that deliberately excludes approximation of the fascial defect. Prospective data were collected on consecutive patients undergoing elective SH repair under the care of a single surgeon between 2001 and 2012. Diagnosis was confirmed preoperatively using ultrasonography or computerized tomography. A laparoscopic TAPP repair was used without closing the defect. Following discharge all patients were followed up at 3 and 12 months. The clinical records were reviewed at the time this article was written. The technique, epidemiological characteristics, operative findings, hospital stay, morbidity, and follow-up are presented. Twenty-six patients (16 males) with a median age of 63 years were operated on. The follow-up period ranged between 6 months and 11 years (median, 4 years). Hernia defect size ranged from 2 to 10 cm. Mean operating time for unilateral defects was 45 minutes; that for bilateral defects was 70 minutes. Twenty-two patients were discharged on the same day. There were no postoperative complications or recurrences. Laparoscopic TAPP repair of SH without closing the defect is safe, effective, and durable. There is no additional benefit from routine closure of the fascial defect. On the contrary, there may be potential advantages in leaving the defect unopposed.

Spigelian Hernia—Diagnostic Dilemma: Case Report with Review

Spigelian hernia (SH) is an uncommon surgical entity in children and rare in adults. Due to various reasons, spigelian hernia can develop through defects in transversus abdominis aponeurosis. Usually spigelian hernia develops below the arcuate line of Douglus and rarely occurs at higher level. It poses a diagnostic dilemma for surgeon as there are no specific symptoms and signs. It comprises about 0.12% of all abdominal wall hernias. The spigelian hernia has been repaired by both conventional and laparoscopic approach. We present a case of spigelian hernia in left half of lower abdomen in a 15-year-old child.

Spigelian Hernia : A Rare Diagnosis for a Common Presentation

Spigelian hernias are rare and generally difficult to diagnose because of their location and vague non-specific symptoms. They are situated between the muscular layers of the abdominal wall and can be easily overlooked because of abdominal obesity. The diagnosis has been considerably aided by the introduction of ultrasonography and computed tomography (CT). These hernias require surgical treatment. We report a 56-year-old male Bahraini who presented to Bahrain Defense Force Hospital Emergency department with severe abdominal pain and vomiting associated with mass in the right iliac fossa. A provisional diagnosis of Spigelian hernia was made and confirmed by CT scan. The hernia was operated and the defect was repaired. His recovery was uneventful.

Spigelian hernia: rare so, beware!

Spigelian Hernia (SH) is a type of interparietal abdominal wall hernia which is usually present at the level of the arcuate line in the area of ‘Spigelian belt’. Hardly, 1000 cases have been reported in surgical literature of which an acute presentation is rarely seen. Hence, we report this case which is an acute variant of Spigelian hernia, with a review of literature to discuss the diagnostic factors and treatment, as such kind of hernias are elusive clinically with fatal outcome, if ignored.

A Case of an Incarcerated Left Spigelian Hernia

A Case of an Incarcerated Left Spigelian Hernia

A Case of a Spigelian Hernia Combined with a Direct Inguinal Hernia

A Case of a Spigelian Hernia Combined with a Direct Inguinal Hernia

Congenital Spigelian Hernia and Ipsilateral Cryptorchidism: Raising Awareness Among Urologists

Spigelian hernias (SHs) are rare in the pediatric population. Although pediatric general surgeons often treat this defect, the increased association between a congenital SH and an ipsilateral undescended testis suggests that urologists may be the first provider encountering this entity. Knowledge of this condition is therefore important. We report one such case of a male infant referred to urology for an undescended testicle. Further investigation revealed the testicle to be within a congenital SH sac. Herein, we additionally review the literature concerning SHs associated with ipsilateral undescended testicles.

Laparoscopic repair for a previously unreported form of ventral hernia on the right iliac fossa in an elderly emaciated woman

An 81-year-old emaciated woman was admitted to our hospital with a one-year history of recurrent bilateral inguinal swellings. Palpable lumps were observed not only in bilateral groin areas, but also on the right iliac fossa (RIF) of her abdomen. During a planned transabdominal preperitoneal laparoscopic herniorrhaphy, a previously unreported form of ventral hernia was observed at a position lateral and cranial to the right internal inguinal ring, which probably corresponded to the palpable lump on the RIF. The hernia orifice was 2 cm in diameter, and a vascular structure ran through the orifice. The contents of the hernia consisted of fatty tissue arising from the retroperitoneal tissue. Routine exploration revealed orifices of the following hernias: left indirect, right direct, bilateral femoral, bilateral obturator, and right Spigelian hernia. Her postoperative course was uneventful and a mass on the right lower quadrant disappeared after operation.

English

Occurrence of Spigelian Hernia is rare accounting for 0.12% of all ventral hernias 1 . It is most commonly reported in adults while pediatric cases are rare. Though the association of Spigelian-Cryptorchidism syndrome has been comprehensively reported in pediatric patients, the same has not been detailed so far for the adult patient population. We herein discuss two cases of Spigelian hernia, both adults in whom intra-operative exploration revealed associated ipsilateral undescended testis. Not only is the pre-operative diagnosis seldom if ever, the imaging studies may not be successful in differentiating the type of hernia2,3. Even in the present cases radiological studies were inconclusive and definitive diagnosis was only attained intra-operatively.

Spigelian hernia treated by laparoscopy

Spigelian hernia treated by laparoscopy

When it is not a Spigelian Hernia: Abdominal Cutaneous Nerve Entrapment Syndrome

Abdominal wall pain at the linea semilunaris is classically the result of a Spigelian hernia. If no hernia is detected, these patients may be left with chronic pain without a diagnosis or treatment. A retrospective review was performed of patients presenting with abdominal wall pain at the linea semilunaris between 2009 and 2012. Of the 14 patients, three (21%) were diagnosed with a Spigelian hernia confirmed by imaging. The remaining patients were eventually diagnosed with abdominal cutaneous nerve entrapment syndrome (ACNES). The average delay in diagnosis was 4 years with patients with ACNES suffering twice as long with chronic pain. Patients with a Spigelian hernia and ACNES had different demographics and presenting complaints. Physical examination findings were nondiagnostic. Of the patients with ACNES, five (50%) had resolution of pain with serial nerve blocks alone; another five proceeded to surgical neurectomy with resolution of their pain. Thus, to prevent delay in diagnosis and treatment, patients with chronic abdominal wall pain at the linea semilunaris should first be ruled out for Spigelian hernia. Then, they should be evaluated and treated for ACNES.

Spigelian Port-site Hernia, a Complication after Laparoscopic Cholecystectomy - a Clinical Case Report

AbstractIntroduction: Spiegelian hernias are rare entities in abdominal wall pathology (2%). They occur in the semilunar line described by Adriaan van den Spiegel. Klinklosch (1764) defined it as a congenital or acquired defect of the transverse abdominal aponeurosis junction with the Douglas arch. Port-site hernias due to wrong placement of laparoscopic trocars in the right abdominal flank are rare, but possible complications of laparoscopic cholecystectomy. Case presentation: Our observation shows diagnostic and therapeutic aspects in a patient with port-site Spigelian hernia post laparoscopic cholecystectomy admitted in Surgical Clinic 1, County Emergency Clinical Hospital Tîrgu Mureș in the 28.01.2013 - 30.01.2013 period. Following surgery performed using an open approach, postoperative evolution was favorable, with no signs of recurrence at 9 months postoperatively. Conclusions: Spigelian port-site hernia post laparoscopic cholecystectomy is a very rare entity, iatrogeny being a certainty in its development

Acute management of a unilateral incarcerated Spigelian hernia in a patient with bilateral Spigelian hernias

Spigelian hernias were first described by Joseph Klinkosch in the 18th century, and have since posed a diagnostic and surgical problem owing to their non-specific presentation and rarity. While the management of unilateral hernias is fairly well described in today's literature, bilateral Spigelian hernias are very rare. We describe the emergency management of a patient with bilateral Spigelian hernias, diagnosed on computed tomography.