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Case Reports
. 2024 Jul:120:109833.
doi: 10.1016/j.ijscr.2024.109833. Epub 2024 May 30.

Complicated Spigelian hernia presenting with sigmoid colon strangulation: A unique clinical report

Saleh A Ba-Shammakh  1 , Bourhan Alrayes  2 , Sami A Almasarweh  3 , Muna A Alseragi  4 , Daher K Rabadi  5
Affiliations
Case Reports

Complicated Spigelian hernia presenting with sigmoid colon strangulation: A unique clinical report

Saleh A Ba-Shammakh et al. Int J Surg Case Rep. 2024 Jul.

Abstract

Introduction and importance: Spigelian hernias are rare, constituting about 1-2 % of all abdominal wall hernias. They present clinically significant challenges due to their potential for incarceration and strangulation. This case report highlights a unique presentation of a Spigelian hernia involving sigmoid colon strangulation, emphasizing the critical need for awareness and timely intervention.

Case presentation: A 60-year-old female with hypertension and diabetes presented with severe left abdominal pain, nausea, and vomiting. Examination revealed leukocytosis, neutrophilia, and signs of acute abdomen. CT imaging showed a complicated left lateral abdominal wall hernia containing the sigmoid colon. Surgical intervention included sigmoidectomy with colorectal anastomosis and hernia repair. Postoperative recovery was successful with subsequent elective ileostomy reversal.

Clinical discussion: The rarity of Spigelian hernias and their atypical presentations can complicate diagnosis and management. This case was particularly challenging due to the strangulation of the sigmoid colon within the hernial sac. Surgical management was necessary to address the incarcerated bowel segment and prevent further complications. This case underscores the utility of CT scans in diagnosing complex cases and guiding surgical strategy.

Conclusion: Despite their rarity, Spigelian hernias carry significant risks of strangulation. Prompt diagnosis and treatment are essential to avoid severe complications. This case highlights the importance of including Spigelian hernia in the differential diagnosis for acute abdominal symptoms, especially when they are nonspecific.

Keywords: Case report; Computed tomography (CT); Sigmoid colon strangulation; Spigelian hernia; Surgical management.

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Conflict of interest statement

Declaration of competing interest None of the authors have any conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
CT Scan of Left Spigelian Hernia with Sigmoid Colon and Perforation Indicators. (a-c): A left-sided lateral abdominal wall hernia with a 3.6 cm wide neck, containing segments of the sigmoid colon. Multiple diverticula are present within the contained bowel segment. Surrounding fat stranding and intra-hernia air foci indicate gas within the hernia. Adjacent subcutaneous fat stranding and intra-abdominal free air foci near the distal sigmoid segment to the hernia site indicate a complicated hernia with bowel perforation.
Fig. 2
Fig. 2
Microscopic Views of Sigmoid Colon with Diverticulum and Transmural Necrosis. a:Diverticulum within the wall. H&E 40×. b:Full thickness, transmural necrosis with thinning of the bowel wall. H&E 40×. c:Transmural necrosis of bowel wall H&E 100×.
See this image and copyright information in PMC

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