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Case Reports
. 2019 Oct 13:2019:8474730.
doi: 10.1155/2019/8474730. eCollection 2019.

Large Strangulated Spigelian Hernia: Management of an Uncommon Presentation of Abdominal Hernias in Central Uganda

Wasingya Lucien  1 , Franck Katembo Sikakulya  2   3 , Kisembo Peter  1 , Atwijukire Vincent  1
Affiliations
Case Reports

Large Strangulated Spigelian Hernia: Management of an Uncommon Presentation of Abdominal Hernias in Central Uganda

Wasingya Lucien et al. Case Rep Surg. .

Abstract

Background: Spigelian hernia is an uncommon presentation of abdominal hernias with 0.1-2%. We report a case of a large strangulated Spigelian hernia, an uncommon presentation of abdominal hernias, and its management in a health facility in Central Uganda.

Case presentation: A 76-year-old female presented with a 2-day history of colicky abdominal pain, bilious vomiting, and abdominal distension. On abdominal ultrasound scan, an abdominal wall defect measuring 4.45 cm with herniated bowel loops in the left anterior abdominal region with mild fluid collection in the hernia sac was seen. Conservative management for intestinal obstruction which included putting the patient on nil per os, NG tube decompression, and soapy enema was instituted, and surgery was done on the second day of admission. Intraoperatively, using a Rutherford-Morrison incision, we found a large defect at the Spigelian aponeurosis, with an inflamed sac protruding. The Spigelian hernia was repaired with a mesh under layers. The patient recovered uneventfully and was discharged 10 days after surgery.

Conclusion: Clinicians and especially general surgeons might be aware of this rare condition in most of the anterior abdominal swellings. Strangulation is the commonest complication of Spigelian hernia, and surgical management remains the mainstay of its treatment.

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Conflict of interest statement

The authors declare that no competing interests exist.

Figures

Figure 1
Figure 1
The location of Spigelian fascia and Spigelian belt (the image was drawn by Zhou Ye) [3].
Figure 2
Figure 2
Abdominal ultrasound scan showing the over-distended bowel in the left anterior abdominal wall.
Figure 3
Figure 3
Abdominal X-ray anteroposterior showing air fluid level with a protrusion in the left anterior abdominal wall.
Figure 4
Figure 4
The defect of Spigelian hernia with contents.
Figure 5
Figure 5
Sac of Spigelian hernia and the inflamed jejunum in a perioperative period.
Figure 6
Figure 6
Operating wound showing the mesh being positioned and being sutured under the layers in the left anterior abdominal wall.
Figure 7
Figure 7
The wound on the anterior abdominal wall after being sutured.
See this image and copyright information in PMC

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