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Spigelian hernia

A Spigelian hernia (or lateral ventral hernia) is a hernia through the spigelian fascia, which is the aponeurotic layer between the rectus abdominis muscle medially, and the semilunar line laterally. These hernias almost always develop at or below the linea arcuata, probably because of the lack of posterior rectus sheath. These are generally interparietal hernias, meaning that they do not lie below the subcutaneous fat but penetrate between the muscles of the abdominal wall; therefore, there is often no notable swelling.

Most of these hernias are small, and, as such, there is a high risk of strangulation. Most of them develop around age 50 (4th-7th decade of life). As an entity, they are rare,^[1] when compared other types of hernias.

Symptoms and diagnosis

Patients typically present with either an intermittent mass, localized pain, or signs of bowel obstruction.^[1] Ultrasonography or a CT scan can establish the diagnosis.

Treatment

These hernias should be repaired because of the high risk of strangulation;^[2] fortunately, surgery is straight-forward, with only larger defects requiring a mesh prosthesis.

Eponym

Adriaan van den Spiegel, a surgeon-anatomist born in Brussels, described this hernia in 1645.

References

^ ^a ^b Larson DW, Farley DR (2002). "Spigelian hernias: repair and outcome for 81 patients". World journal of surgery 26 (10): 1277-81. doi:10.1007/s00268-002-6605-0. PMID 12205553.
^ Vos DI, Scheltinga MR (2004). "Incidence and outcome of surgical repair of spigelian hernia". The British journal of surgery 91 (5): 640-4. doi:10.1002/bjs.4524. PMID 15122618.