Colonic obstruction secondary to incarcerated Spigelian hernia in a severely obese patient

Abstract

Spigelian hernia is a rare hernia of the ventral abdominal wall accounting for 1-2% of all hernias. Incarceration of a Spigelian hernia has been reported in 17-24% of the cases. We herein describe an extremely rare case of a colonic obstruction secondary to an incarcerated Spigelian hernia in a severely obese patient. Physical examination was inconclusive and diagnosis was established by computed tomography scans. The patient underwent an open intraperitoneal mesh repair. A high level of suspicion and awareness is required as clinical findings of a Spigelian hernia are often nonspecific especially in obese patients. Computed tomography scan provides detailed information for the surgical planning. Open mesh repair is safe in the emergent surgical intervention of a complicated Spigelian hernia in severely obese patients.

Keywords: Colon obstruction; Incarceration; Spigelian hernia.

Fig. 1

Computed tomography scan of the abdomen showing a large Spigelian hernia with incarcerated colon, small bowel and omentum. Note the excessive thickness of the subcutaneous fat layer.

Fig. 2

Computed tomography scan of the abdomen showing a large Spigelian hernia with incarcerated colon, small bowel and omentum. Note the wide hernia neck (arrow).

Fig. 3

Intraoperative photo showing the large hernia sac with the incarcerated contents.