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Aoun R, Akel R, Noun R, Chakhtoura G. Peri-appendicular Abscess in a Spigelian Hernia. Surg J (N Y) 2022; 8:e308-e311. [PMCID: PMC9637415 DOI: 10.1055/s-0042-1758044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/01/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background Spigelian hernias are a rare type of lateral ventral abdominal hernia and their content can include any of the intra-abdominal organs. Many cases have described the presence of a variety of abdominal organs in Spigelian hernias, but only few cases report the presence of an incarcerated appendicitis. Imaging is an important step in the diagnosis to avoid the lack of knowledge in such cases. Surgical treatment can be through open or laparoscopic approach, with or without using a mesh according to the size of the defect.
Case Report We report a case of an 82-year-old patient who presented with an acute appendicitis with peri-appendicular abscess strangulated in a right Spigelian hernia. The patient was successfully treated by a laparoscopic appendectomy, a surgical drainage of the abscess, and direct muscle approximation without using of mesh due to inflammation.
Conclusion Spigelian hernias with acute appendicitis in their content are a very rare condition. Clinical diagnosis is usually difficult and challenging and computed tomography scan is the imaging modality of choice. The treatment is surgical.
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Affiliation(s)
- Rany Aoun
- Department of Digestive Surgery, Hotel Dieu de France Hospital, University Saint Joseph Medical School, Beirut, Lebanon
| | - Rhea Akel
- Department of Radiology, Hotel Dieu de France Hospital, University Saint Joseph Medical School, Beirut, Lebanon
| | - Roger Noun
- Department of Digestive Surgery, Hotel Dieu de France Hospital, University Saint Joseph Medical School, Beirut, Lebanon
| | - Ghassan Chakhtoura
- Department of Digestive Surgery, Hotel Dieu de France Hospital, University Saint Joseph Medical School, Beirut, Lebanon
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Anand R, Rahesh J, Ciubuc J, Esparza-Leal K, Schuster A, Jacob R, Brooks SE, Richmond R, Ronaghan CA. Gangrenous appendicitis contained within a Spigelian hernia. Proc (Bayl Univ Med Cent) 2020; 34:104-106. [PMID: 33456162 DOI: 10.1080/08998280.2020.1822131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
A 66-year-old man with abdominal pain had a 5-year-old mass subsequently identified as a Spigelian hernia. Exploratory laparotomy revealed a strangulated and gangrenous appendix contained within the hernia, necessitating an appendectomy. This case highlights the importance of early identification and exploration of this rare hernia, so that early management can prevent the development of more serious and dangerous symptoms.
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Affiliation(s)
- Rohan Anand
- Department of Surgery, Texas Tech University Health Sciences Campus, University Medical Center Hospital, Lubbock, Texas
| | - Jasmin Rahesh
- Department of Surgery, Texas Tech University Health Sciences Campus, University Medical Center Hospital, Lubbock, Texas
| | - John Ciubuc
- Department of Surgery, Texas Tech University Health Sciences Campus, University Medical Center Hospital, Lubbock, Texas
| | - Karla Esparza-Leal
- Department of Surgery, Texas Tech University Health Sciences Campus, University Medical Center Hospital, Lubbock, Texas
| | - Abbie Schuster
- Department of Surgery, Texas Tech University Health Sciences Campus, University Medical Center Hospital, Lubbock, Texas
| | - Roy Jacob
- Department of Surgery, Texas Tech University Health Sciences Campus, University Medical Center Hospital, Lubbock, Texas
| | - Steven E Brooks
- Department of Surgery, Texas Tech University Health Sciences Campus, University Medical Center Hospital, Lubbock, Texas
| | - Robyn Richmond
- Department of Surgery, Texas Tech University Health Sciences Campus, University Medical Center Hospital, Lubbock, Texas
| | - Catherine A Ronaghan
- Department of Surgery, Texas Tech University Health Sciences Campus, University Medical Center Hospital, Lubbock, Texas
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Cox MJ, Adiamah A, Chowdhury A, Shah A. Rare and unusual case of perforated appendicitis in a Spigelian hernia. BMJ Case Rep 2017; 2017:bcr-2017-221851. [PMID: 29183895 DOI: 10.1136/bcr-2017-221851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Michael John Cox
- Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Alfred Adiamah
- Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Abeed Chowdhury
- Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Asim Shah
- Interventional Radiology, Queen's Medical Centre, Nottingham, UK
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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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Peeters K, Huysentruyt F, Delvaux P. An unusual presentation of an incarcerated Spigelian hernia. Acta Chir Belg 2017; 117:312-314. [PMID: 27899054 DOI: 10.1080/00015458.2016.1261984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Spigelian hernias are rare hernias, occurring through a defect in the Spigelian aponeurosis. Like other hernias, they may contain abdominal contents but are more likely to be incarcerated due to the small size of the fascial defect. Multiple intra-abdominal organs have reportedly been found in Spigelian hernias. A search of the literature showed only nine reported cases in which an appendix has been found within a Spigelian hernia. We present a patient with a history of lower abdominal pain since 10 weeks with a large intra-abdominal mass in the right iliac fossa. Due to abscess formation with spontaneous evacuation through the abdominal wall, drainage and incision were performed and the patient was treated with broad-spectrum antibiotics. An explorative laparoscopy after six weeks showed an incarcerated appendix in a Spigelian hernia.
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Affiliation(s)
- Karen Peeters
- Department of General and Abdominal Surgery, AZ Klina Brasschaat, Brasschaat, Belgium
| | - Frederik Huysentruyt
- Department of General and Abdominal Surgery, AZ Klina Brasschaat, Brasschaat, Belgium
| | - Peter Delvaux
- Department of General and Abdominal Surgery, AZ Klina Brasschaat, Brasschaat, Belgium
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Ussia A, Imperato F, Schindler L, Wattiez A, Koninckx PR. Spigelian hernia in gynaecology. GYNECOLOGICAL SURGERY 2017; 14:8. [PMID: 28603476 PMCID: PMC5440533 DOI: 10.1186/s10397-017-1010-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 05/05/2017] [Indexed: 11/10/2022]
Abstract
Background A Spigelian hernia is a rare hernia through the Spigelian fascia between the rectus muscle and the semilunar line. This hernia is well known in surgery. Symptoms vary from insidious to localised pain, an intermittent mass and/or a bowel obstruction. Results The Spigelian hernia is poorly known in gynaecology. Spigelian hernias may be causally related to secondary trocar insertion. This review is written to increase awareness in gynaecology and is illustrated by a case report in which the diagnosis was missed for 4 years even by laparoscopy. Smaller hernias risk not to be diagnosed and will thus not be treated. Even larger Spigelian hernias might not be recognised and treated appropriately. Conclusions The gynaecologist should consider a Spigelian hernia in women with localised pain in the abdominal wall lateral of the rectus muscle some 5 cm below the umbilicus. Smaller hernias can be closed by laparoscopy without a mesh. Larger hernias require a mesh repair.
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Affiliation(s)
- Anastasia Ussia
- Villa Del Rosario, Rome, Italy.,Gemelli Hospitals, Università Cattolica, Rome, Italy
| | | | | | | | - Philippe R Koninckx
- Department of Obstetrics and Gynecology, Catholic University Leuven, University Hospital, Gasthuisberg, B-3000 Leuven, Belgium. Vuilenbos 2 3360, Bierbeek, Belgium
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Anatomical variants and pathologies of the vermix. Emerg Radiol 2014; 21:543-52. [PMID: 24570122 DOI: 10.1007/s10140-014-1206-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 02/10/2014] [Indexed: 12/17/2022]
Abstract
The appendix may demonstrate a perplexing range of normal and abnormal appearances on imaging exams. Familiarity with the anatomy and anatomical variants of the appendix is helpful in identifying the appendix on ultrasound, computed tomography, and magnetic resonance imaging. Knowledge of the variety of pathologies afflicting the appendix and of the spectrum of imaging findings may be particularly useful to the emergency radiologist for accurate diagnosis and appropriate guidance regarding clinical and surgical management. In this pictorial essay, we review appendiceal embryology, anatomical variants such as Amyand hernias, and pathologies from appendicitis to carcinoid, mucinous, and nonmucinous epithelial neoplasms.
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Thomas MP, Avula SK, England R, Stevenson L. Appendicitis in a Spigelian hernia: an unusual cause for a tender right iliac fossa mass. Ann R Coll Surg Engl 2013; 95:e66-8. [PMID: 23676802 DOI: 10.1308/003588413x13511609957731] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Spigelian hernias are a rare type of hernia through the Spigelian aponeurosis, whose contents commonly include omentum or small bowel. In the absence of incarceration or strangulation, they can be difficult to diagnose clinically. In the emergency setting, they can present rarely as a painful abdominal mass and computed tomography provides a reliable diagnostic imaging modality. We report an emergency presentation of a Spigelian hernia containing the appendix.
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Affiliation(s)
- M P Thomas
- North Cumbria University Hospitals NHS Trust, UK.
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Computed tomographic diagnosis of incarcerated Meckel's diverticulum in a patient with bilateral spigelian hernia. J Gastrointest Surg 2012; 16:447-9. [PMID: 21800227 DOI: 10.1007/s11605-011-1638-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 07/12/2011] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Spigelian hernia is an uncommon abdominal wall hernia occurring through the linea semilunaris located near the lateral border of the rectus abdominis muscle. CASE REPORT We report an extremely rare case of incarcerated Meckel's diverticulum within a spigelian hernia diagnosed by multidetector computed tomography.
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