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Lateral Hernias
Published in Jeff Garner, Dominic Slade, Manual of Complex Abdominal Wall Reconstruction, 2020
In a recent large series,12 17% presented as emergencies with obstruction or strangulation and the elective cases presented with intermittent pain at the edge of the rectus sheath, with or without a lump. Older patients were more likely to have a palpable swelling and to have a peritoneal sac, as those under the age of 55 years often have no more than interstitial fat trapped between the muscle layers, making diagnosis very difficult. Such small hernias are often missed on ultrasound and CT, and even at laparoscopy if there is no peritoneal sac component. The diagnosis can usually be made clinically but CT scanning is useful to clarify the anatomy and distinguish Spigelians from incisional hernias, such as laparoscopic port site hernias – the difference is that the external oblique aponeurosis remains intact over Spigelian hernias but not over incisional hernias (Figure 15.10a and b).
The male reproductive system and hernias
Published in Peter Kopelman, Dame Jane Dacre, Handbook of Clinical Skills, 2019
Peter Kopelman, Dame Jane Dacre
Rare types of abdominal wall hernia (Fig. 8.8) include: Obturator hernia – through the obturator foramen.Spigelian hernia – through the lower part of the sheath of the rectus abdominis muscle (which is deficient posteriorly).Lumbar hernia – through the inferior lumbar triangle.Gluteal hernia – through the greater sciatic notch.
Single best answer (SBA)
Published in Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon, Radiology for Undergraduate Finals and Foundation Years, 2018
Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon
Direct inguinal hernias originate infero-medial to the inferior epigastric artery and protrude through a weak point in the abdominal wall fascia. Indirect inguinal hernias originate supero-laterally to this artery, protrude through the deep inguinal ring and usually present in infancy. Spigelian hernias go through the spigelian fascia, the aponeurotic layer between the rectus abdominis muscle and the linea semilunaris. Femoral hernias pass through the femoral canal and obdurator hernias pass through the obdurator foramen.
‘Spigelian-type’ hernia: a rare laparoscopic trocar site hernia following total laparoscopic hysterectomy
Published in Journal of Obstetrics and Gynaecology, 2020
Elizabeth Leong, Amelia Lloyd, Rachel Pounds, Danielle O’Neill, Kavita Singh, Jason Yap
A Spigelian hernia is a protrusion of abdominal contents through a defect in the anterior abdominal wall, along the semi-lunar line (Mittal et al. 2008). A true Spigelian hernia has an intact anterior rectus sheath or aponeurosis of the external oblique muscle. The level of obstruction is between the transverse and internal oblique aponeurosis, causing minimal protrusion, making diagnosis challenging. Spigelian hernias constitute about 1–2% of all reported abdominal hernias (Ussia et al. 2017) and can result in bowel entrapment. Surgical morbidity is high as the frequency of bowel ischaemia is increased compared to umbilical port site hernia, due to the sharp fascial margin around the defect (Mittal et al. 2008). Our case highlights the risk factors for a Spigelian-type hernia development after laparoscopic surgery and discusses rectus sheath closure as a preventative measure. We have classified this as a ‘Spigelian-type’ hernia due to its presentation and level of obstruction mimicking that of a Spigelian hernia. It occurred secondary to trocar insertion and is not a traditional Spigelian hernia since the external aponeurosis had been breached.
Gangrenous appendicitis contained within a Spigelian hernia
Published in Baylor University Medical Center Proceedings, 2021
Rohan Anand, Jasmin Rahesh, John Ciubuc, Karla Esparza-Leal, Abbie Schuster, Roy Jacob, Steven E. Brooks, Robyn Richmond, Catherine A. Ronaghan
Spigelian hernias are a rare subset of hernias that occur through a congenital or acquired slit-like defect in the Spigelian aponeurosis.1,2 Internal structures that protrude through the defect are at high risk for incarceration and subsequent strangulation. With its low incidence,3 a Spigelian hernia is rarely suspected in a patient’s initial workup.