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Ndong A, Tendeng JN, Niang FG, Diao ML, Diallo AC, Ndichout A, Dia DA, Nyemb PMM, Konaté I. Strangulated spigelian hernia with necrosis of the caecum, appendix and terminal ileum: an unusual presentation in the elderly. J Surg Case Rep 2020; 2020:rjaa115. [PMID: 32617146 PMCID: PMC7316440 DOI: 10.1093/jscr/rjaa115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 11/23/2022] Open
Abstract
Spigelian hernia is a rare form of abdominal wall hernias. We report an unusual case of a strangulated spigelian hernia with necrotic contents of the caecum, appendix and terminal ileum in the elderly. An 84-year-old woman, with a history of eight pregnancies, was admitted for bowel obstruction evolving for 7 days. The computed tomography scan showed a strangulated right spigelian hernia. Surgical exploration with an incision centered on the mass confirmed the diagnosis with extensive necrosis of the caecum, appendix and 10 cm of the terminal ileum. A right hemi-colectomy with an ileo-colic anastomosis was performed. The post-operative course was marked by the death of the patient in intensive care due to multi-visceral failure. The occurrence of strangulation with necrosis of the caecum, appendix and terminal ileum in spigelian hernia is extremely rare. It requires early diagnosis and treatment to reduce post-operative morbidity and mortality.
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Affiliation(s)
| | | | | | | | | | - Aicha Ndichout
- Department of Radiology, Saint-Louis Hospital, Saint-Louis, Senegal
| | - Diago Anta Dia
- Department of Surgery, Gaston Berger University, Saint-Louis, Senegal
| | | | - Ibrahima Konaté
- Department of Surgery, Gaston Berger University, Saint-Louis, Senegal
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Incarcerated Spigelian hernia: A rare cause of abdominal wall tender mass. North Clin Istanb 2020; 7:74-77. [PMID: 32232209 PMCID: PMC7103749 DOI: 10.14744/nci.2018.09582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 11/08/2018] [Indexed: 11/20/2022] Open
Abstract
In this study, we aimed to present that incarcerated Spigelian hernia is an important cause of acute abdomen although it is rare and accounts for 1–2% of all abdominal wall hernias. Spigelian hernia arises from a defect in the aponeurosis of the transversus abdominis muscle, also known as the Spiegel fascia. This case analysis aims to present a Spigelian hernia case in which the sigmoid colon is incarcerated. The patient was referred to our emergency surgery clinic complaining of severe abdominal pain and a palpable mass in the left quadrant of the abdomen, presenting tenderness on the front abdominal wall. The symptoms suddenly emerged approximately eight hours ago before the patient was admitted to the hospital. The patient was taken into surgery after the ultrasonography (US) and computed tomography (CT) results suggested a preliminary diagnosis of incarcerated Spigelian hernia for which polypropylene mesh repair was performed. No recurrence was identified in the patient’s control examination performed 22 months later. Incarcerated Speigel hernia should be considered as a cause for patients developing sudden stomach ache and mass, causing tenderness on the front abdominal wall for which mesh repair should be performed.
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Farkas NG, Welman TJP, Ross T, Brown S, Smith JJ, Pawa N. Unusual causes of large bowel obstruction. Curr Probl Surg 2018; 56:49-90. [PMID: 30777150 DOI: 10.1067/j.cpsurg.2018.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 12/10/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Nicholas G Farkas
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
| | - Ted Joseph P Welman
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Talisa Ross
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sarah Brown
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Jason J Smith
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Nikhil Pawa
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Velimezis G, Vassos N, Kapogiannatos G, Koronakis D, Salpiggidis C, Perrakis E, Perrakis A. Strangulation and necrosis of right hemicolon as an extremely rare complication of Spigelian hernia. Arch Med Sci 2016; 12:469-72. [PMID: 27186195 PMCID: PMC4848376 DOI: 10.5114/aoms.2016.59273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 11/10/2014] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Nikolaos Vassos
- Department of Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | | | | | | | - Evangelos Perrakis
- Department of Surgery, Western Attica General Hospital, Athens, Greece
- Department of Surgery, General Hospital Nikea, Piraeus, Greece
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Noomene R, Bouhafa A, Maamer AB, Haoues N, Oueslati A, Cherif A. [Spigelian hernias]. Presse Med 2014; 43:247-51. [PMID: 24439537 DOI: 10.1016/j.lpm.2013.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 06/18/2013] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Rabii Noomene
- Hôpital Habib Thameur, service de chirurgie générale, Tunis, Tunisie.
| | - Ahmed Bouhafa
- Hôpital Habib Thameur, service de chirurgie générale, Tunis, Tunisie
| | - Anis Ben Maamer
- Hôpital Habib Thameur, service de chirurgie générale, Tunis, Tunisie
| | - Noomen Haoues
- Hôpital Habib Thameur, service de chirurgie générale, Tunis, Tunisie
| | | | - Abderraouf Cherif
- Hôpital Habib Thameur, service de chirurgie générale, Tunis, Tunisie
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Turatti RC, Moura VMD, Cabral RH, Simionato-Netto D, Sevillano MM, Leme PLS. Aspectos ultrassonográficos e anatomia da aponeurose do músculo transverso do abdome. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2013; 26:184-9. [PMID: 24190375 DOI: 10.1590/s0102-67202013000300006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 04/28/2013] [Indexed: 11/22/2022]
Abstract
RACIONAL: A avaliação da parede abdominal pela ultrassonografia, tomografia computadorizada e ressonância magnética tem sido cada vez mais indicada para auxiliar no diagnóstico das hérnias quando o exame clínico deixa dúvidas. A correlação de estudos da anatomia da parede abdominal com o exame ultrassonográfico da aponeurose do músculo transverso do abdome pode auxiliar no diagnóstico de uma hérnia desta localização, a hérnia de Spiegel, que se apresenta como doença de diagnóstico clínico difícil. OBJETIVO: Comparar os achados ultrassonográficos da parede anterolateral do abdome, com foco na aponeurose de Spiegel, e a anatomia da parede abdominal estudada em cadáveres não fixados. MÉTODO: A avaliação da aponeurose do músculo transverso do abdome foi realizada durante exames ultrassonográficos de rotina da parede anterolateral do abdome em 90 indivíduos de ambos os gêneros, maiores de 25 anos e estes dados foram relacionados com 60 dissecções da parede abdominal realizadas em cadáveres não fixados. RESULTADOS: Os exames ultrassonográficos não evidenciaram falhas significativas na aponeurose do músculo transverso do abdome nos 90 indivíduos estudados e a largura das aponeuroses de Spiegel variou de 0,83 a 2,93 cm (média de 1,72 cm). Durante as dissecções do transverso do abdome foram encontradas alterações anatômicas em 14 de 60 músculos e aponeuroses estudadas (23,3%) e a largura da aponeurose de Spiegel variou de 1,5 a 3,5 cm (média de 2,26 cm). A comparação entre os grupos etários e gêneros avaliados pelo estudo ultrassonográfico com as dissecções efetuadas em cadáveres não apresentou significância estatística. CONCLUSÃO: Os exames ultrassonográficos não encontraram defeitos na aponeurose do músculo transverso do abdome compatíveis com hérnias, assim como as variações anatômicas e os defeitos encontrados durante as dissecções também não foram acompanhados de hérnias de Spiegel nos cadáveres estudados.
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