Diagnostic Pitfalls of Spigelian Hernia – Case Report

Aims: Spigelian hernias are rare type of ventral hernias. They account for 0.1- 2% of all abdominal wall hernias. As they are interparietal, only 50% of patients are diagnosed clinically.

Presentation of Case: 60-year-old woman presented with acute lower abdominal pain of two hours duration. For the last four years, she experienced similar episodes of pain lasted around thirty minutes. Pain subsided spontaneously on arrival to hospital each time. Though she was evaluated on multiple occasions, definitive cause was not identified. During this admission, there was a tender abdominal lump on palpation. On USS abdomen, an obstructed spigelian hernia was found. The patient was taken to operation theatre for emergency laparotomy. While waiting for the surgery, her abdominal pain got better and hernia reduced spontaneously. So, we postponed her surgery and later, the patient underwent hernial repair under routine theatre list.

Discussion: Clinical diagnosis of spigelian hernia is challenging because it is rare, small and difficult to palpate. Dynamic Ultrasonography and CT abdomen are useful in confirming the diagnosis. Surgical exploration remains the mainstay of treatment.

Conclusion: Clinicians should have a high index of suspicion for spigelian hernia in patients presenting with nonspecific abdominal pain without palpable mass. Early diagnosis and prompt management help to reduce acute life-threatening complications such as incarceration and strangulation.