Laparoscopic treatment of small bowel incarceration and perforated appendix within right-sided spigelian hernia: case report and review of the literature

Abstract

Spigelian hernia is a rare disease and a quarter of the patients present with incarceration or strangulation of the hernia content and require emergency surgery. We report a case of an elderly obese woman with comorbidity presented with abdominal pain and right flank palpable mass. The contrast enhanced computer tomography showed bowel incarceration within right side spigelian hernia. Only at laparoscopic exploration a diagnosis of appendicitis within spigelian hernia was made and the patient underwent laparoscopic appendicectomy and open debridement of the abscess with primary closure of the defect. The postoperative stay was uneventful. Few cases of appendicitis within spigelian hernia have been reported in literature and, as in our case, the diagnosis is usually difficult and laparoscopy has a key role in the diagnosis and treatment of those patients also in emergency setting. Early repair decreases the rate of morbidity related to this condition.