Management of Spigelian hernia caused by necrobiotic fibroma of the uterus in a pregnant woman

Abstract

Introduction: Spigelian hernias are a rare type of hernia through the Spigelian aponeurosis. Spigelian hernias are very uncommon and constitute only 0.12% of all abdominal wall hernias. These hernias are located in the aponeurosis of the internal oblique muscle and transverse abdominal muscle.

Presentation of case: A 30-year-old woman at 28 weeks' gestation was admitted to the obstetrics department due to pain and swelling in the anterior abdominal right region. On inspection, we suspected either a lipoma, a spontaneous hematoma, a tumor of the abdominal wall, or a Spigelian hernia. A Doppler USG and abdominal and pelvic Magnetic Resonance Imaging revealed necrobiotic fibroma of the uterus in Spigelian hernia. The patient was started on dual analgesic and corticotherapy. Overall, the patient improved one week after the acute episode and had no further pain during her gynecologic follow-up.

Discussion: We have reported a first case of Spigelian hernia that was complicated by uterine fibroid. The clinical presentation varies, depending on the contents of the hernial sac and the degree of herniation. MRI is the preferred method for accurately identifying masses of the abdominal wall. Our treatment options were based on the extent of the acute-phase reaction and the venous thrombosis.

Conclusion: It is important to differentiate this rare Spigelian hernia from other hernias as the treatment for this hernia is medical rather than surgical. Before the final choice of treatment is made, digestive surgeons should bear this rare hernia in mind.

Keywords: Magnetic Resonance Imaging; Necrobiotic fibroma; Pregnant woman; Spigelian hernia; Surgery.

Fig. 1

Image of the patient's abdomen with a Spigelian hernia. (1) Spigelian hernia. (2) Spigelian aponeurosis. (3) The transversus abdominis. (4) Rectus abdominis muscle. (5) Linea alba. (6) Costal cartilage.

Fig. 2

Doppler USG of the anterior abdominal area. (1) Circumferential vascularity. (2) Absence of flow.

Fig. 3

Abdominal Magnetic Resonance Imaging-T1 was performed and revealed uterine fibroid in Spigelian hernia (arrow). (1) Transverse abdominis. (2) Internal oblique. (3) Spigelian hernia. (4) Linea Semilunaris. (5) Rectus abdominis. (6) Uterus. (7) Fetus.

Fig. 4

Abdominal Magnetic Resonance Imaging-T2 was performed and revealed uterine fibroid in Spigelian hernia (arrow). (3) Spigelian hernia. (4) Linea Semilunaris. (6) Uterus. (7) Fetus.