Spigelian hernia case report and review of literature

Spigelian hernia is rare and accounts for less than 0.1% of abdominal wall hernias. It is often diagnosed at the complication stage. Authors report the case of a 48-year-old obese patient who had a painful swelling of the right iliac fossa. Morphological examination data were in favour of a strangled spigelian hernia and surgical exploration had shown a hernial sac with epiploic contents with a narrow collar. It was performed a resection of the retracted epiploon with simple raphy. The postoperative course was uneventful. Diagnostic and therapeutic difficulties are discussed through a literature review.

Hernias poco comunes: hernia de Spiegel. Reporte de caso / Uncommon hernias: Spigelian hernia. Case report

La hernia de Spiegel es un defecto infrecuente de la pared abdominal producido por una alteración en la unión del borde lateral del músculo recto del abdomen y el borde medial del músculo transverso del abdomen en la línea semilunar. Representan apenas del 0,12 al 2% de todas las hernias. La presente investigación se enfocó en describir las manifestaciones clínicas, el diagnóstico, la incidencia, el procedimiento quirúrgico y su evolución en dos casos reportados. Caso 1: Femenina de 33 años, multípara, obesa, quien consulta por dolor y masa palpable en el cuadrante superior izquierdo del abdomen. Al examen físico, se evidenció dolor a la palpación en mesogastrio e hipocondrio izquierdo, exhibiendo protrusión del contenido abdominal, en la línea de Spiegel. Intervención quirúrgica: hernioplastia protésica de Spiegel con colocación de malla supraaponeurótica. Caso 2: Masculino de 89 años, con diagnóstico de EPOC, acudió a consulta presentando dolor abdominal en fosa iliaca y en la región inguino­escrotal izquierda. Al examen físico se evidenció saco herniario en la región inguino­escrotal por lo que se decide su resolución quirúrgica. Como hallazgo transoperatorio se evidenció defecto aponeurótico del recto anterior del abdomen izquierdo en su tercio inferior. Intervención quirúrgica: hernioplastia protésica de Spiegel con colocación de malla supraaponeurótica.Conclusión : La hernia de Spiegel es una entidad poco frecuente por lo que se debe concientizar al cirujano para sospechar este tipo de hernia en aquellos pacientes con presencia de aumento de volumen en la línea de Spiegel(AU)

Spigelian hernia is an infrequent abdominal wall defect caused by an alteration in the joint between lateral edge of the rectus abdominis muscle and the medial egde of the transverse abdominis muscle in the semilunar line. It represent only from 0.12 to 2% of all hernias. This investigation is focussed on describe the clinical manifestations, diagnosis, incidence, the surgical procedure and its evolution in two reported cases. Case 1: A 33 years old female, multiparous, obese, who consulted for pain and palpable mass in the left upper quadrant of the abdomen. Physical examination revealed tenderness between mesogastrium and left hypochondrium, showing protrusion of abdominal content, in the Spigelian line. Surgical intervention: Prosthetic Spiegel hernioplasty with supraaponeurotic mesh. Case 2: An 89 years old male, diagnosed with COPD, attended in the consultation presenting abdominal pain in the iliac fossa and in the left inguino-scrotal region. Physical examination revealed hernial sac in the inguino-scrotal region, reason which its surgical resolution is decided. As an intraoperative finding, an aponeurotic defect of the anterior rectus of the left abdomen was evidenced in its lower third. Surgical intervention: Prosthetic Spiegel hernioplasty with supraaponeurotic mesh.Conclusion : Spigelian hernia is a rare entity, so the surgeon must be focused on suspect this kind of hernia in patients with growth in Spiegel line(AU)

Traumatic Spigelian Hernia in Adults: A Rare Clinical Scenario

Handlebar hernias are very rare and arise following a sudden force from a handle-like object impacting a focal area of the abdomen, which results in a disruption of the underlying abdominal muscle and fascia without necessarily disrupting the overlying skin. Other than a reducible swelling on the abdominal wall, the physical examination of such patients is usually unremarkable and the diagnosis could easily be missed. Delay in the diagnosis can lead to incarceration or strangulation of bowel loops and subsequent morbidity. A large proportion of reported cases are in children. Here, we are reporting a case of traumatic Spigelian hernia following blunt trauma in an adult male. The significance of our case is that it provides some evidence that blunt trauma to abdomen may play an etiological role in development of some Spigelian hernias in adult as well.

Hernia de spiegel. Nuestra experiencia / Spigelian hernia. Our experience

Introducción: La Hernia de Spiegel es una afección parietal rara de la pared abdominal, unilocular, que se localiza en el borde externo de la línea semilunar. La mayoría de las veces se encuentra ubicada bajo el músculo oblicuo mayor y corresponde a una hernia intersticial; por lo que puede pasar desapercibida. Objetivo: Describir nuestra experiencia en el diagnóstico y tratamiento de la hernia de Spiegel. Pacientes y método: estudio observacional, descriptivo, retrospectivo de pacientes con diagnóstico de Hernia de Spiegel, tratados en la II Cátedra Clínica Quirúrgica, en el período de tiempo comprendido desde marzo 1998 a diciembre 2015. Resultados :n 14, fueron del sexo femenino 8 pacientes y 6 del masculino, el promedio de edad 57,4(±50-85). El motivo de consulta: dolor abdominal de tipo difuso, acompañado de una tumoración ventro lateral, reductible. En 10 casos la tumoración se localizó en el lado derecho y en 4 en el lado izquierdo.La sospecha clínica fue confirmada por la ecografía en 8 casos y la tomografía axial computarizada en los 6 restantes, la forma de presentación de 2 casos fue como oclusión intestinal y operados de urgencia y las demás electivas - ambulatorias. En todos los casos se realizó reparación de la pared sin tensión con malla de polipropileno, en 3 pacientes se colocó plug y en 11 pacientes se realizó refuerzo de la fascia del oblicuo mayor sublay, con el mismo material. No tuvimos complicaciones ni recidivas a los 24 meses. Conclusión: El diagnóstico de la hernia de Spiegel no resulta sencillo, debe acompañarse en todos los casos de un estudio de imagen. La técnica quirúrgica sin tensión, colocación de malla sublay, es una opción por sus resultados satisfactorios.

Introducción: Spigelian Hernia is a rare abdominal wall disease, often localizated in semilunar line. Most of the time it appeas under external oblique muscle, because of that, sometimes the diagnosis can be difficult. Objective: To describe the experience in the diagnosis and treatment of Spigelian Hernia. Patient and methods: An observational, retrospective study of patients with Spigelian Hernia, at the Second Service of Surgery, between March of 1998 to December of 2015. Results: 14 patients were diagnosed of Spigelian Hernia, 8 women and 6 men, with an average age of 57 years (±50-85). The main reason from consultation was abdominal pain with a lateral abdominal tumor. Clinical suspicious was confirm by ultrasonography in 8 cases and CT scan revealed the other 6. Surgical treatment in all cases was performed without tension using a polipropilene mesh; in 3 of them they use a plug and in the other 11 a sublay mesh to reinforce the external oblique fascia. They don´t have any complications. Conclusion: The diagnosis of Spigelian Hernia is not simple, is important to attach a image study. A tension free surgical technique, a sublaymesh, are options to have success.

Spigelian Hernia with Homolateral Direct Inguinal Hernia: A Rare Case Report.

A Spigelian hernia (or lateral ventral hernia) is a hernia through the spigelian fascia, which is the aponeurotic layer between the rectus abdominal muscle medially and the semilunar line laterally. There is a common misconception that they protrude below the arcuate line owing to deficiency of the posterior rectus sheath at that level, but in fact, the defect is almost always above the arcuate line. These are interparietal hernias, meaning that they do not lie below the subcutaneous fat but penetrate between the muscles of the abdominal wall; therefore, there is often unnoticeable swelling. Spigelian hernias are usually small, and therefore, the risk of strangulation is high. Most occur on the right side (4-7th decade of life).

A Rare Case Report of Spigelian Hernia

Introduction spigelian hernias (SH) represent 0.12–2.4% of all abdominal wall hernias. Its diagnosis is elusive and requires a high level of conjecture given the disease rarity, vague-associated abdominal complaints and frequent lack of consistent physical findings. Presentation of case A 40-year-old woman presented with a history of chronic pain in the right lower side of the abdomen. The patient was treated for several diseases with no relief of symptoms. Abdominal ultrasound showed an SH in the lower right abdomen and surgery was scheduled for treatment. Discussion an SH is generally an inter-parietal hernia, meaning that the pre-peritoneal fat and the hernia sac penetrate the transversus abdominis and internal oblique muscles but remain behind the external oblique aponeurosis. In most of the patients the lack of clinical signs demands the importance of radiological investigation especially high grade which is. That's the importance of the high grade of suspicion of the disease during the physical exam. The surgical repair is necessary due to the high risk of incarceration-related complications, which can occur in up to 21% of cases. Conclusion diagnostics and history of abdominal pain is important in diagnosing SH as it cause of lower abdominal pain to prompt indicate surgical repair and provide the patient's symptom relief. Also the type of repair is dependent on the surgeon's choice and also the means available in each centre.

Hernia de Spiegel / Spigelian hernia: report of 23 cases

Background: Spigelian hernia (SH) can be defined as the protrusion of preperitoneal fat or a peritoneal sac containing or not containing an intra-abdominal organ, across a congenital or acquired defect in the Spigelian line. These hernias are also known as "spontaneous lateral ventral hernias", "hernia of the semilunar line," or "hernias through the conjoint tendon". Aim: To report the clinical features of this type of hernia. Material and Methods: Review of medical records of 23 patients aged 36 to 83 years (16 females) with Spigelian hernia treated in a lapse of 10 years. Results: Fifty two percent of the patients were obese. The hernia was unilateral in all patients and in 70 percent of cases, it was located in the left side. All patients referred pain. A palpable mass was found in 83 percent. An ultrasound was required to confirm the diagnosis in 22 percent of patients. All were subjected to elective surgery, with local anesthesia. No relapse has been detected. Conclusions: Spigelian hernia is uncommon and usually presents with pain. Its surgical correction can be carried out with local anesthesia.

La hernia de Spiegel es infrecuente. Existen en Latinoamérica pocas publicaciones sobre este tema. El objetivo de esta presentación es dar cuenta, mediante 23 casos, de algunos aspectos de su presentación. El siguiente es un estudio observacional descriptivo, que analiza una serie de pacientes intervenidos con el diagnóstico de hernia de Spiegel en nuestro centro en un período de 10 años. Los instrumentos de análisis fueron la ficha clínica, la información existente en la base de datos EpiInfo del servicio y una entrevista personal. La hernia de Spiegel constituyó el 0,9 por ciento de 2.568 operaciones de pared realizadas en nuestro servicio, fue más frecuente en mujeres y en el lado izquierdo (69,5 por ciento), la edad promedio fue de 59,5 (36-83) años. Fue unilateral en todos los casos. La obesidad estuvo presente en el 52 por ciento de los pacientes. El dolor estuvo presente en todos los pacientes y una masa palpable fue encontrada en 19 (82,6 por ciento). Se necesitó ecotomografia en 5 (21,7 por ciento) para corroborar el diagnóstico. La totalidad de la serie fue operada de manera electiva y con anestesia local. No se han detectado complicaciones ni recidivas a la fecha. Concluimos que la hernia de Spiegel es rara y su forma de presentación más frecuente es con dolor. Factores de riesgo como la obesidad deben ser tenidos en cuenta. La ecotomografia ayuda al diagnóstico, pero no es necesario utilizarla de rutina. La cirugía ambulatoria con anestesia local permitió el tratamiento en todos los casos.

Trauma-related Acute Spigelian Hernia in Right Upper Abdomen

Trauma-related spigelian hernia is a rare event that has been reported only sporadically. Because of its rare nature and nonspecific physical findings, its diagnosis is difficult. This hernia most commonly presents at the level of the semicircular line known as the arcuate line. A 70-year-old man was admitted after overturn of his cultivator. A scratch wound surrounding a cutaneous sign of the cultivator handlebar impact was evident on his right upper abdominal wall. Trauma-related spigelian hernia occurred in the site of the handlebar impact. We report this cases of trauma-related spigelian hernia that was treated by primary repair with a brief review of the literature.

Estudo anatômico da parede anterior do abdome em cadáver e hérnia de Spiegel / Anatomical study of the ventral abdominal wall in cadaver and Spigelian hernia

OBJETIVO: Tentar correlacionar a hérnia de Spiegel com eventuais alterações anatômicas da parede anterolateral do abdome. Abordar as particularidades do estudo anatômico em cadáver, com destaque aos músculos oblíquo interno, transverso abdominal, aponeurose de Spiegel, linha semilunar e ao aparecimento de hérnias de Spiegel. MÉTODO: A parede anterolateral do abdome foi dissecada em 31 cadáveres frescos do Departamento de Patologia da Santa Casa de Misericórdia de São Paulo, sendo realizada nos dois primeiros cadáveres a dissecção unilateral e nos 29 restantes o estudo bilateral da parede abdominal, completando 60 dissecções. Considerando que operamos no Hospital São Luiz Gonzaga, da Irmandade da Santa Casa de Misericórdia de São Paulo, 13 doentes com 14 hérnias de Spiegel, pudemos correlacionar os elementos clínicos aos estudos anatômicos em cadáver. RESULTADOS: Defeitos encontrados nos músculos e aponeuroses: Oblíquo externo: 4/60 (6,6 por cento) - Oblíquo interno: 6/60 (10 por cento) - Transverso abdominal: 14/60 (23,3 por cento). Disposição dos músculos em forma de feixes de fibras: Oblíquo interno: 10/60 (16,6 por cento) - Transverso abdominal: 12/60 (20 por cento). CONCLUSÕES: As variações anatômicas e os defeitos encontrados, durante as dissecções do oblíquo interno e transverso abdominal, não se acompanharam de hérnias de Spiegel no cadáver, já a gordura pré-peritoneal, dissecando as fibras da aponeurose de Spiegel e oblíquo interno, foi encontrada nas operações e nas dissecções, podendo representar uma relação entre os defeitos musculoaponeuróticos da parede anterolateral do abdome e a hérnia de Spiegel.

BACKGROUND: The present anatomical study on cadavers has been undertaken together with examinations of patients operated, with the particular aim of investigating the transversus abdominis, internal oblique muscles, Spigelian aponeurosis, semilunar line and the occurrence of Spigelian hernias. METHOD: Ventral abdominal wall was dissected in thirty-one cadavers, being the first two a unilateral dissection and the other twenty-nine a bilateral study of the abdominal wall, totalling sixty dissections. Considering that we operated thirteen patients with forteen Spiegelian hernias at Hospital São Luiz Gonzaga, from Irmandade da Santa Casa de Misericórdia de São Paulo, we were able to study clinical elements and compare them to the cadaveric material. RESULTS: Muscular and aponeurotic malformation: external oblique muscle: 4/60 (6,6 percent) - internal oblique muscle: 6/60 (10 percent) - transverse abdominal: 14/60 (23,3 percent). Unusual muscular fibers arrangement: internal oblique muscle: 10/60 (16,6 percent) - transverse abdominal: 12/60 (20 percent). CONCLUSIONS: The anatomical variations in muscular defects of the cadaveric material didn't match up to Spigelian hernias. The preperitoneal fat found between the fibers of Spigelian aponeurosis and the internal oblique muscle both in the surgery and in the cadaveric material might stand for a relation between musculoaponeurotic defects and the Spigelian hernias.

Laparoscopic Repair of a Spigelian Hernia

A spigelian hernia is a rare hernia of the lateral wall and is difficult to diagnose and localize before surgical exploration. We report the case of a spigelian hernia treated by using laparoscopy. The laparoscopic approach affords an accurate appraisal of the defect and a direct means of repair. More extensive use of laparoscopy, instead of open exploratory surgery, is recommended for the evaluation and repair of such hernias.

A Case of Spigelian Hernia in Upper Abdomen

Spigelian hernia is an uncommon hernia of the ant. abdominal wall. Because of its insidious nature and nonspecific physical findings, the diagnosis of this hernia is often not made. Typically, the hernia orifice is small, and strangulation of the contents of the hernial sac can occur. Computed tomography permits the distinction between Spigelian hernia and other anterial abdominal wall or intraabdominal masses. Spigelian hernia requires surgical correction to prevent complication of acute abdomen with strangulation or incarceration. The typical site of a Spigelian hernia is at the level of the semicircular fold of Douglas known as the arcuate line. Spigelian hernia can occur above the umbilicus, high Spigelian hernia, but its very unusual site. We report a case of Spigelian hernia on upper abdomen and review the literature.

Spigelian hernia in children: report of two cases and review of the literature

Two children with spigelian hernias are presented in this report. The etiopathogenesis and surgical anatomy of these rare hernias were discussed. Our cases are the fourth and fifth cases of spigelian hernia (SH) in patients under 2 years of age. Surgical intervention is indicated in all cases of SH because of the danger of strangulation of the bowel.