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.

Abstract: Spigelian hernia represents 0.1 to 2% of abdominal wall hernias; It is a defect in the aponeurosis of the transverse and oblique abdominal muscles between the lateral border of the rectus abdominis sheath and the semilunar line. CLINICAL CASE. A 43-year-old male with morbid obesity, type 2 Diabetes Mellitus, and Systemic Arterial Hypertension. He started suffering from abdominal pain of more than 36 hours of evolution, nausea and vomiting of gastro biliary content, and a fever of 38.7 ° C; found a painful tumor, which indicated a Computed Axial Tomography, which reported intestinal obstruction and hernial defect of the abdominal wall. Indicated Exploratory Laparotomy. Made a supra and infra umbilical incision in the previous scar. It is dissected by planes, finding a three cm hernial defect in the upper vertex of the previous scar with a fibrous sac, adhesions, and transverse colon content without vascular compromise and reduced content. Subsequently, we proceeded to identify a right paramedian ventral hernia with a six cm defect without being able to reduce the hernial sac along the midline, for which is made a right transverse incision; dissected by planes, identifying hernial sac with necrotic, fetid, non-perforated small intestine contents, performed adhesiolysis, reduced the defect, and performed a 150 cm ileum resection with stump closure; washed the cavity, the stoma was exteriorized and matured, and it was closed in layers. DISCUSSION. Spigelian hernia is a rare differential diagnosis of abdominal pain. This type of hernia mainly affects women over the fifth decade of life, with a higher incidence on the left side, generally with comorbidities that lead to Int. J. Med. Healthc. Res. 2023, Vol. 1. Issue 1 2 of 7 increased intra-abdominal pressure or weakened abdominal fascia, such as COPD, cirrhosis, obesity, and pregnancy. Keywords: Spigelian hernia; Incarceration; sigmoid colon; General surgery; Hernia surgery

Spigelian hernias are rare, making up only 1-2% of all hernias. Like other hernias, they may contain abdominal contents but are more likely to be incarcerated due to the small size of the fascial defect.(1) We describe here the case of a 71-year-old female with a 10-year history of right lower quadrant pain that remained undiagnosed despite multiple imaging studies. Prior to presentation the patient developed a new bulge and increasing pain at this site; an ultrasound revealed the presence of a bowel-containing hernia. The patient was taken urgently to the operating room for a laparoscopic Spigelian hernia repair, and was found to have an incarcerated appendix in the hernia. After the hernia was reduced, an appendectomy was performed and the hernia was repaired with biological mesh. Postoperatively, the patient did well, and her pain resolved.

Spigelian hernia is a rare clinical entity. It is difficult to diagnose due to its location. In this article we report the case of a giant spigelian hernia consequent to abdominal wall injury. The neck of the hernia was 10 cm in diameter. We repaired this hernia with a polypropylene mesh.

Spigelian hernias are rare abdominal wall defects that occur at the semilunar line lateral to the rectus abdominis muscle. They are situated between the muscular layers of the abdominal wall and can be easily overlooked because of abdominal obesity. Generally difficult to diagnose because of their location and vague non-specific symptoms radiographic studies have been beneficial in confirming the diagnosis. The diagnosis has been considerably aided by the introduction of ultrasonography and Computed Tomography (CT). Once the diagnosis is made operative management is indicated due to chances of incarceration. We report a 48 years old patient from the IMS and SUM hospital, Bhubaneswar, Odisha, India who presented with colicky lower abdominal pain associated with a non-tender swelling above and lateral to the left inguinal canal. A diagnosis of Spigelian hernia was made and confirmed on exploration. The hernia was reduced and the defect repaired. His recovery was uneventful.