Spigelian hernia or lateral ventral hernia is the rare type of a hernia that develops through the spigelian fascia. Clinical diagnosis of a suspected hernia can be challenging owing to vague presenting symptoms and signs. A spigelian hernia is a rare hernia through the spigelian fascia between the rectus muscle and the semilunar line. However, the spigelian hernia was first described and defined by josef klinkosch in 1764. Traditionally, an anterior hernioplasty was used to repair these defects. We hereby present a rare case of large spigelian hernia. First described in 1764 by josef klingosh, spigelian hernias are an uncommon. The diagnosis of a spigelian hernia is traditionally difficult if only given a history and physical examination. A good medical exam is done and imaging tests are also done to eliminate other health conditions. It should be treated immediately when diagnosed as further delay could pose a danger to other organs in.
Spigelian hernias are a rare type of abdominal wall hernia involving a break. Spigelian hernia symptoms, ct, pictures, causes, repair procedure. Spigelian hernias most often need surgical repair and fixation of the defect due to their anatomical presentation making them at high risk of serious complications such as strangulation and incarceration5. No evidence existed that the 7cm midline incision made for handassisted laparoscopy was related to the spigelian hernia defect. Role of imaging in the diagnosis of occult hernias surgery. Spigelian hernia showing itself as a left lower abdominal.
The incidence of spigelian hernias is increasing, which may be related to widespread use of highquality crosssectional imaging, misdiagnosis of lateral incisional hernias eg, port site hernia as spigelian hernias, or a true increase due to the obesity epidemic. Spigelian hernia is confirmed based on ct scan results. Shows the position of spigelian hernia image source. Meshfree laparoscopic spigelian hernia repair request pdf. The spigelian hernia sac will be reduced of its contents before adhesiolysis is done. Because spigelian hernias tend to be small, the risk of developing a strangulated hernia is higher. This uncommon hernia might cause multiple diagnostic difficulties in physical examination. One hundred and one patients underwent surgery for 107 spigelian hernias in the 10year period. Spigelian hernia is defined as a herniation of a sac of peritoneum or an organ, through a weak. An ultrasound examination of the abdomen was performed using a. Sonographic assessment of a spigelian hernia sage journals. Spigelian hernia spigelian hernia, also known as lateral ventral hernia, is a type of abdominal hernia along the semilunar line.
Spigelian hernias most often need surgical repair and fixation of the defect due to their anatomical presentation making them at. The choice of surgical treatment to repair spigelian hernia depends on the surgeons preference and. Laparoscopic diagnosis and repair of spigelian hernia. Sometimes heredity will factor in a person developing a spigelian hernia. Spigelian hernia is a lifethreatening hernia that can occur in all people. A spigelian hernia is a hernia through the spigelian fascia or layer of tissue that separates two groups of abdominal muscles. An unusual presentation of spigelian hernia incarceration. Spigelian hernia pictures anatomy, symptoms and repair. Semilunar line is the curved line on either side of the abdomen. It usually occurs in people between 5070 years, most commonly in women.
Spigelian hernias tend to occur more rarely than other types of hernias. The diagnosis of a spigelian hernia is traditionally difficult if. Role of imaging in the diagnosis of occult hernias. Timely computed tomography scan diagnoses spigelian hernia. The goal is to locate the hernia orifice and create ports with 10 cm distance away from the affected area. In the period from 1995 to 2001 785 anterior abdominal wall hernias were diagnosed including 11 spigelian hernias 1. Jan 02, 2018 however, with a spigelian hernia, the main symptom that most people notice is a pain. Jun 15, 20 although imaging is rarely needed to diagnose a hernia, it may be useful in certain clinical situations e. Diagnosis of spigelian hernia must be based on a proper clinical history and a thorough physical examination, and it is advisable to perform an ultrasonogram or computed tomography in cases in which there is diagnostic doubt. Depending on the size of the hernia opening and the contents of the hernia sac, a spigelian hernia can affect the body in different ways. Spigelian hernia in gynaecology gynecological surgery.
The diagnostic potential of ct and sonography in detecting clinically unrecognized cases of spigelian hernia is illustrated and discussed. Spigelian hernias are also known as spontaneous hernias because they can develop suddenly after injury or trauma to the abdomen area. Risk factors were present in 74% of patients and a history of previous abdominal operation was the most frequent one. Sep 30, 2012 spigelian hernia, also referred to as lateral ventral hernia, in the majority of cases is of acquired character and is related to hard physical work, overweight, multiple labors, cough and ascites, so the conditions in which there is an increase in intraabdominal pressure 210. I guess the next question is what imaging test do you think is the most likely to pick up on the presence of a spigelian hernia. A spigelian hernia or lateral ventral hernia everything. The spigelian hernia has been repaired by both conventional and laparoscopic approaches. Number 3 is the arcuate line just above the monro line.
Objective to determine the effectiveness of imagingultrasonography us, computed tomography ct, and magnetic resonance imaging mriin the diagnosis of occult inguinal hernia. The spigelian hernia belt shows the possible areas in which the hernia can be formed. Ahernia is the protrusion of a part or structure through the tissues normally containing it, either through an opening in the tissues or via stretching of the tissue wall. Reformatted computed tomographic scan is the best imaging modality. The intestine, stomach, colon, omentum, and ovaries can be affected if they are inside the hernia sac. Most of the time when laparoscopy has been used as a treatment modality for spigelian hernia it has been done by transabdominal approach. The key radiographic findings are air or contrast filled bowel seen laterally outside the confines of the peritoneal cavity, the beak sign of hernia, the sharp constriction of the proximal herniated loop, and the intermittent nature of the hernia. It is the protuberance of, omentum, adipose or bowel in that weak space between the stomach muscles, that ultimately pushes the. Spigelian hernias also known as lateral ventral hernias occur due to defects in the lateral abdominal wall.
This type of hernia normally is caused by pressure intraabdominally pushing out a portion of an abdominal organ into the abdominal muscle layers. Mri in spigelian hernia t1 weighted images in axial and sagittal plane, t2 fs images in axial plane of an 80 year old male presenting with palpable swelling in the right ventral abdominal wall shows focal herniation of mesenteric omental fat and vessels through a defect in the right spigelian aponeurosis that of the internal oblique and. It was reduced by applying gradually increasing pressure with the ultrasound probe, whilst. Spigelian hernias may be causally related to secondary trocar insertion. Spigelian hernia pictures, location, causes, treatment. A spigelian hernia is a very rare hernia, making up approximately 0. Sonographic imaging of spigelian hernias researchgate. 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. Ultrasound showing a spigelian hernia being reduced.
Spigelian hernia symptoms, pictures, recovery time. With the advancement in laparoscopic hernia repair, there is evidence that spigelian hernias too can be repaired laparoscopically, thereby causing less morbidity and shorter hospital stay. Spigelian hernia is a hernia through spigelian fascia, which is the aponeurotic layer that is a layers of flat broad tendons that joins the muscles and it is located between the rectus abdominis muscle or also known as six pack medially and the semilunar line, it is a curved line placed on either side of rectus abdominis, laterally. Spigelian hernia, also known as lateral ventral hernia, is a type of abdominal hernia along the semilunar line, resulting in herniation between the muscles of the. External abdominal hernias are usually found in the inguinal region, where most are direct and indirect inguinal hernias and femoral hernias 2, 3.
Because of its high rate of incarceration, surgery should be performed as soon as a spigelian hernia is diagnosed. This is a layer of abdominal muscles that rests between the lateral edge of the rectus muscle and the linea semilunaris. It occurs along the lateral edge of the rectus muscle and aponeurosis of the transverse abdominus muscle. The symptoms of the patient were vague and nonspecific. The hernia defect was located 4 to 5 cm lateral to the midline incision. Spigelian hernia is rare and requires a high index of suspicion given the lack of consistent symptoms and signs. For women, hernias can be a pain crade 2016 journal. College of surgeons national surgery quality improvement program. Because of the location, swelling is often minimal with little outward signs of a hernia, allowing the condition to go undetected. We believe that detecting hernias in female patients is a skill that anyone physician and sonographer expert in gynecologic sonography can and should master for a complete evaluation of the female patient in pain. These hernias are unique that they are mostly intraparietal which makes them difficult to diagnose clinically. Because of the difficulty of physical examination, patients presenting with symptomatic hernias are often misdiagnosedfor example, symptoms of a leftsided spigelian hernia can be mistaken for diverticulitis.
This is a layer of abdominal muscles that rests between the lateral edge of. Spigelian hernia is a very rare hernia of the abdominal wall. Laparoscopic diagnosis of incarcerated spigelian hernia. Sonographic imaging of spigelian hernias europe pmc. Most abdominal wall hernias should be evaluated by a surgeon when identified. The major issue that is generally associated with hernia is their location to develop. A hernia is a protrusion, bulge, or projection of an organ or part of an organ through the body wall that normally contains it. A spigelian hernia or lateral ventral hernia is a hernia through the spigelian fascia, which is the aponeurotic layer between the rectus abdominis muscle medially, and the semilunar line laterally. With the advancement in laparoscopy, reports detailing laparoscopic repair of spigelian hernia have now started to come up 2, 3. It may be a challenge to figure out what is causing your symptoms. Patient with chronic lower abdominal pain and with normal physical exam and imaging studies revealed to have a spigelian hernia.
Here, we present a rare case of large spigelian hernia that posed to us as a diagnostic dilemma. Spigelian hernia, also known as lateral ventral hernia, is a type of abdominal hernia along the semilunar line, resulting in herniation between the muscles of the abdominal wall. A spigelian is the type of ventral hernia where aponeurotic fascia pushes through a hole creating a bulge. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Left side was the most frequent location, 17 patients 44% and three patients 8% had a bilateral spigelian hernia. Spigelian hernias are uncommon and predominantly affect the abdominal wall. Only when the tear through the abdominal muscles has worsened can a person see the outward appearance of it through the skin. The following video, ultrasound imaging of hernia posted by 123radiology posted in 2015, is approx 43 minutes long but worth it, i think. An umbilical hernia occurs when a weak spot in the belly allows a bit of fat, fluid, or intestine to push through, creating a lump or bulge near the belly. Abdominal wall hernias are typically classified by location or etiology. This hernia goes through a defect in the spigelian fascia which is the part of the transversus abdominis aponeurosis lateral to the rectus muscle, often at the level of the arcuate line, where the fascia is widest and weakest. Clinical evaluation of recurrent hernias is usually limited due to the existence of mesh made of nonabsorbable material, and tissue fibrosis or large body habitus, contraction of the abdominal wall muscles, or any cause of distension. Frequently asked questions on operative technique of.
A spigelian hernia forms through the spigelian aponeurosis. It is the aponeurotic layer that is the layer of flat broad tendons that join the muscles and it is located between the rectus abdominous muscle and semilunar other words, it is the protrusion of peritoneal fat or sac of. In 41% the spigelian hernia appeared concomitantly with other type of abdominal wall hernia. Spigelian hernia are rarely reported lateral abdominal wall hernias. It should be treated immediately when diagnosed as further delay could pose a danger to other organs in the abdomen, and the body at large. A spigelian hernia is the protrusion of preperitoneal fat, peritoneal sac, or viscera through a congenital. The diagnosis of spigelian hernia relies on the hernia orifice located in the spigelian aponeurosis. Here you can find all important information about this disease like its symptoms, diagnosis and treatment so keep reading. Radiological and clinical examination in the diagnosis of. The adhesions were lysed, and the hernia was reduced and repaired. The patient underwent laparoscopic repair of her spigelian hernia the following day and made a fast and uneventful recovery. Jun 19, 2017 a spigelian hernia forms through the spigelian aponeurosis. They account for less than 1% of all hernias diagnosed in the adult population. Because of its small size, it has a high risk of incarceration.
Spigelian hernia wikimili, the best wikipedia reader. Background spigelian hernia is a rare variant of the ventral hernia protruding from a. Due to the improvements in imaging modalities, it is recognized more and more frequently. The muscles are called the rectus muscles and the lateral obliques. How is total extraperitoneal spigelian hernia repair done. It appears in the stomachs lower quadrant between an area of dense fibrous tissue and abdominal wall muscles causing a spigelian aponeurosis. A hernia will usually cause a distinct bulge where the tissue or organ pushes through the muscle wall. Hernia is formed when it penetrates between spigelian. In conclusion, spigelian hernia is rather a rare type of abdominal hernia. Ultrasound imaging or a ct scan will provide better imaging for the detection of a hernia than an xray. Although most abdominal hernias are asymptomatic, the fear of developing complications like. This case illustrates the importance of imaging a patient whilst symptomatic if the diagnosis of a spigelian hernia is entertained.
Feb 09, 2015 ultrasound showing a spigelian hernia being reduced. A spigelian hernia, also known as a lateral ventral hernia, develops through the spigelian fascia, the muscles found in the abdominal wall whereas most other hernias develop just below layers of fat. A spigelian hernia is caused by intraabdominal pressure that pushes a portion of an abdominal organ into the layers of abdominal muscle that make up the abdominal wall. The patient had not sought medical advice previously. An astute physician may couple a proper history and physical examination with preoperative imaging to secure the diagnosis.
Spigelian hernia pictures, symptoms, location, causes. Spigelian hernia symptoms, ct, pictures, causes, repair. The valsalva maneuver helps to demonstrate widening of the defect with contents moving distally as well as narrowing. Hernias may be associated with significant morbidity and even. Patients usually have a painful mass in the midtolower abdomen, which is sometimes reducible in the supine position. Ct provides the exact location, content and signs of. Abdominal wall hernias are usually suggested by the patients history and confirmed by physical examination. In the period from 1995 to 2001 785 anterior abdominal wall hernias were diagnosed, in which in 10 patients 7 women and 3 men aged from 38 to 65 11 spigelian hernias 1. It will start out as mild discomfort in the region, which consistently worsens over time. A right spigelian hernia with a 3cm wide mouth was the cause of the smallbowel obstruction. Jun, 2016 the external oblique fascia is often intact over the hernia, so that on physical examination, an abdominal wall bulge or defect can often not be detected.
Laparoscopic intraperitoneal onlay mesh for spigelian hernia repair. When diagnosing a spigelian hernia it can take some time because of the vague symptoms. They may also use a medical imaging study to look at your abdominal wall to see if there is a hernia there. These hernias are unique that they are mostly intraparietal which makes them difficult to. May 06, 2014 a number of repairs have been described in the literature for spigelian hernias. Symptoms vary from insidious to localised pain, an intermittent mass andor a bowel obstruction. Spigelian hernia symptoms, pictures, location, anatomy. This study aimed to investigate the accuracy of preoperative imaging and clinical examination in the diagnosis of spigelian hernias.
The size of the hernia correlated with the ct finding, and the bowel was viable. Contemporary thoughts on the management of spigelian hernia. The diagnosis was further confirmed by intraoperative findings. The combination of physical exam findings and imaging is usually sufficient for the diagnosis of spigelian hernias. Objective to determine the effectiveness of imaging ultrasonography us, computed tomography ct, and magnetic resonance imaging mriin the diagnosis of occult inguinal hernia. Role of ultrasonography and multidetector ct in imaging. Spigelian hernia symptoms, pictures, recovery time, surgery. The spigelian hernia is poorly known in gynaecology. Spigelian hernias occur through a slit like defect in the anterior abdominal wall adjacent to the semilunar line. The nature of the repair depends upon the size and location of the.
Sonographic assessment of a spigelian hernia danielle j. A preoperative diagnosis of spigelian hernia has become more feasible because of crosssectional ct imaging and ultrasound. These imaging modalities can promptly and reliably diagnose spigelian hernia based on the following findings. A spigelian hernia is a congenital defect in the transversus aponeurosis fascia. The incidence of spigelian hernias after colonoscopy is even rarer with only one case outlined in the surgical literature. I know these types of hernias are fairly rare but it also might be because they are so difficult to diagnose so that they are undereported and undetreated and the patient has to always wonder what the source of their pian is until the hernia possibly. Sep 25, 2016 the following video, ultrasound imaging of hernia posted by 123radiology posted in 2015, is approx 43 minutes long but worth it, i think.