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Duke B, Grozenski A, Kiel J. Spigelian Hernia Secondary to Blunt Trauma. Curr Sports Med Rep 2021; 20:137-139. [PMID: 33655994 DOI: 10.1249/jsr.0000000000000818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Blake Duke
- University of Florida-Jacksonville, Jacksonville, FL
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Azar SF, Jamadar DA, Wasnik AP, O'Rourke RW, Caoili EM, Gandikota G. MDCT imaging in Spigelian hernia, clinical, and surgical implications. Clin Imaging 2021; 74:131-138. [PMID: 33493970 DOI: 10.1016/j.clinimag.2020.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/24/2020] [Accepted: 12/28/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Spigelian hernia is an uncommon congenital or acquired defect in the transversus abdominis aponeurosis with non-specific symptoms posing a diagnostic challenge. There is a paucity of radiology literature on imaging findings of Spigelian hernia. The objective of this study is to explore the role of MDCT in evaluating Spigelian hernia along with clinical and surgical implications. MATERIALS AND METHODS In this IRB approved, HIPAA compliant retrospective observational analysis MDCT imaging findings of 43 Spigelian hernias were evaluated by two fellowship-trained radiologists. Imaging features evaluated were: presence of Spigelian hernia, laterality, relation to "hernia belt" (between 0 and 6 cm cranial to an imaginary axial line between both anterior superior iliac spines), the hernia neck and sac sizes, hernia content, and other coexistent hernias (umbilical, incisional, inguinal). Patient's demographics (age, gender, BMI, conditions with increased intra-abdominal pressure) were also recorded for any correlation. RESULTS 60% (26/43) of Spigelian hernias were located below the hernia belt while 33% (14/43) within the hernia belt and 7% (3/43) above the hernia belt. The most common subtype of Spigelian hernia encountered was interparietal (84%). The mean hernia neck diameter was 3.4 cm, mean hernia sac volume was 329 cc. Hernia content included: fat (43/43) bowel (23/43), fluid (3/43). 3 patients had no clinical history provided, the remaining 37 patients' clinical presentation was asymptomatic in 73% (27/37), acute abdominal pain in 5% (2/37) and chronic abdominal pain in 22% (8/37). None of the hernia were incarcerated and none of the patients underwent emergent surgery. No significant correlation was noted between Spigelian hernia and causes of increased intra-abdominal pressure. 90% of our patients had other abdominal hernias. 30.9 was the mean BMI (20.8-69.1). CONCLUSION Most of the Spigelian hernia occurred below the traditionally described hernia belt and the majority are of interparietal subtype that can be best diagnosed with MDCT in contrast to physical examination.
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Affiliation(s)
- Shadi F Azar
- Department of Radiology, University of Michigan Medical School, Ann Arbor, MI 48109, USA; Ann Arbor VA Healthcare System, Radiology Services, Section of Abdomen Imaging, 2215 Fuller Rd, Ann Arbor, MI 48105, USA.
| | - David A Jamadar
- Department of Radiology, University of Michigan Medical School, Ann Arbor, MI 48109, USA; Radiology Services, Section of Musculoskeletal Imaging, Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Rd, Ann Arbor, MI 48105, USA.
| | - Ashish P Wasnik
- Department of Radiology, Section of Abdomen Imaging, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI 48109, USA.
| | - Robert W O'Rourke
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA; Department of Surgery, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA.
| | - Elaine M Caoili
- Department of Radiology, Section of Abdomen Imaging, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI 48109, USA.
| | - Girish Gandikota
- Department of Radiology, Section of Musculoskeletal Imaging. University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI 48109, USA.
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Kuzan TY, Kuzan BN, Sadıkoğlu B, Tüney D. Spigelian Hernia Including the Urinary Bladder: A Rare Potential Cause of Surgical Complication. J Radiol Case Rep 2019; 13:8-12. [PMID: 31565172 DOI: 10.3941/jrcr.v13i3.3490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Spigelian hernia is a rare type of anterior abdominal wall hernia. While it is itself very rare, seeing urinary bladder in this hernia is even rarer. Here, in this case, we specifically illustrate a rare case of Spigelian hernia including the urinary bladder, diagnosed with computerized tomography.
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Affiliation(s)
- Taha Yusuf Kuzan
- Department of Radiology, Health Science University, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Beyza Nur Kuzan
- Department of Radiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Bilal Sadıkoğlu
- Department of Radiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Davut Tüney
- Department of Radiology, Marmara University School of Medicine, Istanbul, Turkey
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Di Furia M, Romano L, Salvatorelli A, Brandolin D, Lazzarin G, Schietroma M, Carlei F, Giuliani A. Giant Spigelian Hernia presenting as small bowel obstruction: Case report and review of literature. Int J Surg Case Rep 2019; 63:118-121. [PMID: 31585321 PMCID: PMC6796652 DOI: 10.1016/j.ijscr.2019.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/26/2019] [Accepted: 09/16/2019] [Indexed: 11/28/2022] Open
Abstract
Spigelian Hernia is a rare abdominal wall hernia. Urgent presentation with small bowel obstruction is uncommon. Laparoscopy could be an option in elective surgery but in emergent setting laparotomy is required. Mesh repair is mandatory to avoid recurrence.
Introduction Spigelian Hernia is an uncommon pathology of abdominal wall (0.12–2.4%), usually small sized and with vague symptoms. It rarely presents as Small Bowel Obstruction or reaches dimensions that becomes clinically remarkable. Presentation of case 84-year-old woman entered our Surgical Department for Small Bowel Obstruction due to a giant (8 × 7 cm) abdominal wall hernia, which was intraoperatively identified as Spigelian Hernia. We performed a minilaparotomy with reduction of viable small bowel and preperitoneal positioning of polypropilene mesh. Postoperative course was uneventfull. Discussion Due to its small dimensions and infrequence, the diagnosis could be challenging even if the patient undergoes a CT scan. The presentation with clear signs of small bowel obstruction associated with a large abdominal hernia is rare and suggests a urgent surgical approach with mesh repair to avoid recurrences. Conclusion Even if rarely symptomatic, the Spigelian Hernia is an entity to consider in the differential diagnosis of small bowel obstruction in a virgin abdomen. Preoperative diagnosis, when available, is mandatory to guide a correct surgical approach.
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Affiliation(s)
- Marino Di Furia
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, Italy.
| | - Lucia Romano
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, Italy
| | - Andrea Salvatorelli
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, Italy
| | - Denise Brandolin
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, Italy
| | - Gianni Lazzarin
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, Italy
| | - Mario Schietroma
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, Italy
| | - Francesco Carlei
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, Italy
| | - Antonio Giuliani
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, Italy
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Kwok AMF, Sarofim M, Still AB. Terminal ileum within a Spigelian hernia: a rare presentation of small bowel obstruction. ANZ J Surg 2019; 89:E564-E565. [PMID: 30690818 DOI: 10.1111/ans.14976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 10/24/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Allan M F Kwok
- Department of Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Mina Sarofim
- Department of Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Andrew B Still
- Department of Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
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Xu L, Dulku G, Ho R. A rare presentation of Spigelian hernia involving the appendix. Eur J Radiol Open 2017; 4:141-143. [PMID: 29159208 PMCID: PMC5683672 DOI: 10.1016/j.ejro.2017.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/01/2017] [Accepted: 11/01/2017] [Indexed: 11/29/2022] Open
Abstract
Spigelian hernia (SH) is a rare entity accounting for 1–2% of ventral abdominal wall hernias. Elusive clinical signs and symptoms pose a diagnostic challenge and a consequent risk of strangulation. We present an emergent case of a Spigelian hernia involving the appendix.
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Affiliation(s)
- Ling Xu
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, WA, Australia
| | - Gurjeet Dulku
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, WA, Australia
| | - Richard Ho
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, WA, Australia
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Bevilacqua M, Ahmed S, Miller M, Sallee D, Angel W. Case of Spigelian hernia with incarcerated appendix. J Radiol Case Rep 2017; 10:23-28. [PMID: 28580057 DOI: 10.3941/jrcr.v10i11.2815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Spigelian hernias are uncommon lateral ventral wall hernias with a significant rate of incarceration; these hernias often produce nonspecific clinical signs and symptoms as well as elusive imaging findings. Although there are reported cases of incarcerated appendices within Spigelian hernias, this case specifically illustrates the diagnostic difficulty these hernias present to both surgeons and radiologists. Additionally, we discuss important anatomy, demographics and risk factors, clinical symptoms, imaging pitfalls and recommendations for repair based on a review of literature.
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Affiliation(s)
- Michael Bevilacqua
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Saif Ahmed
- Department of Surgery, Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - Mark Miller
- Methodist - LeBonheur Healthcare, Methodist Germantown Hospital, Memphis, TN, USA
| | - David Sallee
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Wesley Angel
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, USA
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Abstract
Describes the existence of endometrioma in a spigelian hernia sac. Spigelian Hernia is a rare ventral hernia, presenting difficulties in diagnosis and carrying a high incarceration and obstruction risk. Endometriomas occur due to implantation of endometrial cells into a surgical wound, most often after a cesarean delivery. A 37-year-old woman presented to our department with persistent abdominal pain, exacerbating during menses, and vomiting for 2 days. Physical examination revealed a mass-like lesion in the border between the left-upper and left-lower quadrant. Ultrasound examination was inconclusive and a computed tomography scan of the abdomen revealed an abdominal wall mass. During surgery, a spigelian hernia was found 5 to 7 cm above a previous cesarean incision. Tissue like "chocolate cysts" was present at the hernia sac. Hernia was repaired while tissue was excised and sent for histological examination that confirmed the diagnosis. Spigelian hernia is a hernia presenting difficulties in diagnosis and treatment. Endometrioma in a spigelian hernia sac is a rare diagnosis, confirmed only histologically. Clinical suspicion can be posed only through symptoms and thorough investigation.
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Barnes TG, McFaul C, Abdelrazeq AS. Laparoscopic Transabdominal Preperitoneal Repair of Spigelian Hernia—Closure of the Fascial Defect Is Not Necessary. J Laparoendosc Adv Surg Tech A 2014; 24:66-71. [DOI: 10.1089/lap.2013.0407] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Thomas G. Barnes
- Colorectal Unit, Department of Surgery, Warrington & Halton Hospitals NHS Foundation Trust, Warrington, United Kingdom
| | - Chris McFaul
- Colorectal Unit, Department of Surgery, Warrington & Halton Hospitals NHS Foundation Trust, Warrington, United Kingdom
| | - Ayman S. Abdelrazeq
- Colorectal Unit, Department of Surgery, Warrington & Halton Hospitals NHS Foundation Trust, Warrington, United Kingdom
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