A Rare Case of Spigelian Hernia

Case Studies

SPIGELIAN HERNIA- A CASE REPORT

Authors- Dr.Anand Kumar J, Dr. Kavya Tere

Department of General & Laparoscopic Surgery & Minimal Access Surgery, SUGUNA HOSPITAL.

Discussion.
Spigelian hernia is named after Adriaan van Spieghel, who described the semilunar line.The hernia appears to peak in the 4th to 7th decades. The male to female ratio is 1:1.18. Spigelian hernias are very uncommon and constitute only 0.12% of all abdominal wall hernias.Spigelian hernias occurs through slit like defects in the anterior abdominal wall adjacent to the semilunar line which extends from the tip of the ninth costal cartilage to the pubic spine at the lateral edge of the rectus muscle inferiorly. Most of spigelian hernias occur in the lower abdomen where the posterior sheath is deficient. It is also called “spontaneous lateral ventral hernia” or “hernia of semilunar line”. The hernia ring is a well-defined defect in the transversus aponeurosis.

The diagnosis of spigelian hernia is difficult as the hernia is interparietal with no obvious mass on inspection or palpation and is complicated by that the defect continues to expand laterally and caudally between two oblique muscles.

Symptoms can vary from abdominal pain, lump in the anterior abdominal wall or patient may have history of incarceration with or without intestinal obstruction. Pain often can be provoked or aggravated by maneuvers that increase the intra abdominal pressure and is relieved by rest. It is known to go in early for incarceration and strangulation due to narrow defect. Hence early detection and operative surgery is key to management.

Case Report

We hereby present a case of 52yr old female with complaints of pain abdomen on and off. She has history of lscs surgery. She is an obese female with BMI more than 30 kg/m2.On examination there was a small mass palpable in right illiac fossa with cough impulse, with suspicion of incisional hernia.

Patient was planned for hernioplasty in SUGUNA HOSPITAL after all pre anesthetic evaluation.

Operative findings- Under spinal anaesthesia Transverse incision was taken over the small swelling after marking it pre operatively. only after opening the external oblique aponeurosis was a large defect in internal oblique aponeurosis and transversalis fascia noted with large sac bulging through the defect . Sac was opened , contents found to be omentum with adhesions to sac. Adhesiolysis done, defect was closed internaly with prolene 1-0 suture . Space created beneath the external oblique aponeurosis and prolene mesh 15*10 cm placed and anchored with prolene 2-0. Drain was kept and external oblique aponeurosis closed with prolene No.1. wound was closed in layers. Patient withstood procedure well and was started orally and ambulated same day post operatively.

Conclusion

Spigelian hernias are treacherous and have a real risk of strangulation. The risk of strangulation is higher because of sharp fascial margin around the defect. For this reason, surgery should be advised in all patients. Hence should have high degree of clinical suspicion and early detection helps in safe management of the patient. In our case surgical challenge was obese patient and hernial defect closure, which due to the surgical expertise able to tackle and bring a good outcome.