Spigelian hernia: Our total extraperitoneal approach and a systematic review of the literature

A Case Report on a Hybrid Approach to Managing Acute Large Bowel Obstruction Secondary to Spigelian Hernia

Spigelian hernias are an uncommon type of primary ventral hernia and are defined as a defect in the Spigelian aponeurosis (fascia). Herein, we present an uncommon case of Spigelian hernia to highlight the potential complications of these hernias and the need for surgical management. This is a case report of an 86-year-old gentleman presenting post-fall with an acute rib fracture and an incidental Spigelian hernia seen on a CT trauma pan scan. The Spigelian hernia surgical treatment was planned for elective management due to the anesthetic risks associated with an elderly patient and acute rib fractures. Ultimately, the patient developed a large bowel obstruction secondary to the Spigelian hernia and required emergency operative management to relieve the obstruction. The patient had an uncomplicated recovery following his emergency surgery. This case report highlights the importance of assessing anesthetic risks versus surgical risks when it comes to surgical planning. Clinicians should recognize occult hernias and continue ongoing clinical reviews with a high index of suspicion, as symptoms of Spigelian hernia obstruction might be non-specific.

Spigelian hernia diagnosis: Case report

INTRODUCTION AND IMPORTANCE

Spigelian hernia is a rare abdominal wall hernia, representing 0.1 to 2 % of all ventral hernias. Clinically, the signs and symptoms are nonspecific and unclear.

CASE PRESENTATION

Here, we present a 69-year-old female patient, with abdominal bulging in both iliac fossae. Imaging exams suggested Spigelian hernia and right inguinal hernia. The treatment was surgical, with placement of polypropylene meshes and the patient had an uneventful postoperative evolution.

CLINICAL DISCUSSION

The characteristics of this case corroborate the current literature, which points to a greater involvement of adults aged between 40 and 70 years. The treatment of choice is surgery, which can be open or videolaparoscopic, with placement of a mesh or primary suture.

CONCLUSION

The clinical presentation of Spigelian hernia is not characteristic and its diagnosis should be suspected during the investigation of an abdominal mass.

Epiploic appendagitis in a Spiegel hernia: A case report and review of the literature

INTRODUCTION

Spigelian hernia is a rare differential diagnosis of abdominal pain. It affects mainly women above the fifth decade of life, more on the left side than on the right side, usually with comorbidities that lead to an increase in intra-abdominal pressure, described as risk factors for the outbreak of ventral hernias. The content of a ventral hernia might be an epiploic appendix and lead to appendagitis.

PRESENTATION OF CASE

This article presents the case of an 82-year-old female patient who presented epiploic appendagitis in a Spigelian hernia.

DISCUSSION

Spigelian hernia is a rare type of ventral hernia, especially in association with an epiploic appendagitis. A literature search of this rare entity yielded three publications presenting epiploic appendagitis in a Spigelian hernia. The initial approach after the diagnosis should be adequate analgesia associated with surgical correction of the hernia. There is no gold standard treatment for the repair. European and American societies suggest that if there is no palpable nodule, laparoscopic repair is preferable, always using a mesh.

CONCLUSION

Epiploic appendagitis in a Spigelian hernia is a rare condition whose diagnosis is a big challenge. However, the correct diagnosis can lead to a shorter hospital stay, with less cost and avoid the use of unnecessary medications.