“Bulb-like” sign: Small bowel closed loop obstruction in incarcerated Spigelian hernia

Cesaro, Edoardo; Rocco, Concetta; Rosano, Nicola; Ferrandino, Giovanni; Marra, Ester; Rispoli, Corrado; Maio, D; Lugarà, Marina; Tamburrini, Stefania; Marano, I.

doi:10.1016/j.radcr.2020.12.038

Cited by 6 publications

(4 citation statements)

References 10 publications

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“…Spigelian hernia is a rare abdominal wall hernia arising from the Spigelian fascia between the semilunar line and the lateral border of the rectus abdominis [ 1 ]. Although the fascial defects are often small and easily strangulated, they are often already retracted at the time of examination, in which case it is not always easy to identify the defect of hernia from the body surface and diagnosis becomes difficult [ [2] , [3] , [4] ]. Ultrasonography and CT scan are used for diagnosis [ [5] , [6] , [7] , [8] ], but ultimately, surgical findings are the most important for surgeon.…”

Section: Introductionmentioning

confidence: 99%

The advantage of laparoscopic surgery in the treatment of Spigelian hernia: A report of two cases

Takayama

Okada

Nakatani

et al. 2021

International Journal of Surgery Case Reports

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Introduction and importance The usefulness of laparoscopic surgery in the treatment of Spigelian hernias and the appropriate insufflation pressure remains unclear. Case presentation Case 1 involved an 81-year-old woman presented with a right abdominal protrusion. CT scan demonstrated a defect in the abdominal wall at the lateral edge of the right rectus abdominis muscle. We diagnosed as Spigelian hernia and performed laparoscopic hernia repair. The insufflation pressure was set at 10 cm H 2 O, and the IPOM method was selected as the repair method. Case 2 involved a 74-year-old male presented with a right abdominal painful bulging. Strangulation was released and CT scan demonstrated a defect in the abdominal wall at the lateral edge of the right rectus abdominis muscle. We diagnosed as Spigelian hernia and performed laparoscopic hernia repair. The insufflation pressure was set at 10 cmH 2 O, and the repair was performed by the hybrid method. Clinical discussion In both cases, the positions of the hernia portals marked preoperatively based on the tender areas and confirmed laparoscopically were not accurate. Although Spigelian hernia is a rare disease and various laparoscopic techniques have been reported in recent years, laparoscopic surgery is very useful to obtain an accurate diagnosis and to observe the abdominal wall from inside the abdominal cavity under insufflation, and it is better to decide the repair method according to the situation of each case and institution. Conclusion Laparoscopic surgery is important for accurate diagnosis in surgery of Spiegel's hernia, and insufflation pressure of 10 cmH2O was sufficient.

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Section: Introductionmentioning

confidence: 99%

The advantage of laparoscopic surgery in the treatment of Spigelian hernia: A report of two cases

Takayama

Okada

Nakatani

et al. 2021

International Journal of Surgery Case Reports

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“…In emergency departments, 2–8% of patients are patients with SBO, and of these patients about 16% are admitted to the surgical unit [ 96 , 97 , 98 ]. The most common cause of SBO is adhesion, in 55–75% of cases [ 99 ], followed by hernias and tumors [ 100 , 101 , 102 ]. Tumor is the cause of colon obstruction in about 60% of cases, while volvulus and diverticular disease occur in about 30% [ 94 , 103 ].…”

Section: Intestinal Obstructionmentioning

confidence: 99%

Point-of-Care Abdominal Ultrasonography (POCUS) on the Way to the Right and Rapid Diagnosis

et al. 2022

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Point-of-Care ultrasound (POCUS) is based on target ultrasound that is performed wherever a patient is being treated, and by a non-radiologist directly involved in the patient’s care. It is used either for quick diagnosis or procedural guidance. Abdominal pain is one of the most common complaints in emergency departments, and POCUS can help in the differentiation of patients who need additional diagnostic tests or hospital treatment, which eventually reduces the overall costs of health care. POCUS has high sensitivity and specificity in abdominal pathology, it can be helpful in the evaluation of biliary, intestinal, and urinary tract, and it is especially used in trauma. Additionally, the gold standard for abdominal aortic aneurysm detection, follow up and screening is precisely this diagnostic procedure. Unfortunately, the quality of ultrasound examination can be affected by the experience of the physician performing it and the patient’s body weight. There is no doubt that POCUS is being increasingly recognized, but all motivated physicians should be provided with dedicated tutors and enough time for learning. This would certainly help to implement this diagnostic method as a routine in emergency and critical care departments, and significantly shorten the time until definitive diagnosis.

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“…Once the obstructive fulcrum has been identified, it is advisable to try to find the cause of the obstruction, easier in the case of a hernia or extraluminal mass [ 7 ], but more difficult and not always possible through ultrasound in the case of adhesions or bridles. The identification of the level of the obstruction point location is possible because the different portions of the intestine can be recognized thanks to their topography and specific morphological criteria.…”

Section: Ultrasound Techniquementioning

confidence: 99%

“…The cause of mechanical obstruction can be intraluminal (gallstones, vegetative tumors, or foreign bodies), intramural (stenosis generated by parietal infiltration of the tumoral process or by an inflammatory reaction, e.g., Crohn’s disease), or extraintestinal (bands, adhesions, carcinosis, retro/intraperitoneal mass). The most frequent cause of small bowel occlusion is adhesions, followed by hernias and neoplasm; in developing countries, infectious causes (such as abdominal tuberculosis) should be considered [ 5 , 6 , 7 , 8 , 9 ]. Although adhesions resulting from prior abdominal surgery are the predominant cause of SBO, accounting for 60% to 75% of cases, SBO should not be excluded in patients without any history of previous surgical procedure (‘virgin abdomen’).…”

Section: Introductionmentioning

confidence: 99%

Ultrasound of Small Bowel Obstruction: A Pictorial Review

Rosano¹,

Gallo

Mercogliano

et al. 2021

Diagnostics

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Small bowel obstruction (SBO) is a common condition requiring urgent attention that may involve surgical treatment. Imaging is essential for the diagnosis and characterization of SBO because the clinical presentation and results of laboratory tests may be nonspecific. Ultrasound is an excellent initial imaging modality for assisting physicians in the rapid and accurate diagnosis of a variety of pathologies to expedite management. In the case of SBO diagnosis, ultrasound has an overall sensitivity of 92% (95% CI: 89–95%) and specificity of 93% (95% CI: 85–97%); the aim of this review is to examine the criteria for the diagnosis of SBO by ultrasound, which can be divided into diagnostic and staging criteria. The diagnostic criteria include the presence of dilated loops and abnormal peristalsis, while the staging criteria are represented by parietal and valvulae conniventes alterations and by the presence of free extraluminal fluid. Ultrasound has reasonably high accuracy compared to computed tomography (CT) scanning and may substantially decrease the time to diagnosis; moreover, ultrasound is also widely used in the monitoring and follow-up of patients undergoing conservative treatment, allowing the assessment of loop distension and the resumption of peristalsis.

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“Bulb-like” sign: Small bowel closed loop obstruction in incarcerated Spigelian hernia

Cited by 6 publications

References 10 publications

The advantage of laparoscopic surgery in the treatment of Spigelian hernia: A report of two cases

The advantage of laparoscopic surgery in the treatment of Spigelian hernia: A report of two cases

Point-of-Care Abdominal Ultrasonography (POCUS) on the Way to the Right and Rapid Diagnosis

Ultrasound of Small Bowel Obstruction: A Pictorial Review

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