Strangulated Spigelian Hernia: A Diagnostic Challenge with Rare Case Report

Abstract

Background: Spigelian hernia, is a rare abdominal wall anomaly with an incidence of 0.1-2%, was initially documented by Josef Klinkosh in 1764. This hernia protrudes through the Spigelian aponeurosis, a continuation of the transversus abdominis muscle’s aponeurosis situated between the rectus abdominis muscle’s lateral border and the linea semilunaris. They primarily occur within the spigelian hernia belt, a region below the umbilicus delineated by the anterior superior iliac spines. These are often misdiagnosed as lateral incisional hernias (eg, port site hernia).There’s no clear sex predilection, and most patients are diagnosed in the fifth or sixth decade of life.
Methods: A 56-year-old woman presented with acute onset and severe abdominal pain persisting for four days, accompanied by bilious vomiting. She had history of intermittent pain and swelling in left abdomen for more than 20 years and had undergone Hysterectomy with bilateral salpingo-oophorectomy 11 years earlier. Clinical examination revealed a palpable 5x5 cm lump in the left iliac fossa, with tenderness and mild erythema of overlying skin. Non-contrast abdominal CT confirmed a bowel loop protruding through an abdominal wall defect.
Results: Exploratory laparotomy revealed a gangrenous ileal segment of about 10 cm and segmental resection followed by anastomosis by single layer interrupted technique was done.
The patient recovered well during a 5-day hospital stay and continued follow-up without complications.
Conclusion: This case report emphasizes the importance of diagnosing spigelian hernia with increased risk of strangulation in patients with prior abdominal surgery. A high index of suspicion is needed for early diagnosis resulting in better outcomes.