Ovarian endometriosis may be associated with an increased incidence of both ovarian cancer and endometrial polyps. Careful evaluation for coexistent pathology should be undertaken in women with symptomatic endometriosis.

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.

We recommend bilateral oophorectomy for all women with a positive family history of ovarian carcinoma and for all women undergoing hysterectomy after the age of 40. The decision for prophylactic oophorectomy as a complementary procedure to other indicated gynecologic surgeries should depend on the individual patient and her ability to comply with lifelong estrogen replacement therapy.