Low Spigelian hernia in a 6-year-old boy presenting as an incarcerated inguinal hernia: a case report

Abstract

IntroductionLower Spigelian hernia is a very rare entity. The clinical findings are similar to those of inguinal hernias and in many cases may be misdiagnosed. In the literature, only a few references to this entity have been reported in children. To the best of our knowledge, this is the first case report of a lower Spigelian hernia in a child who presented with an acute painful scrotum.Case presentationWe discuss the case of a 6-year-old Greek boy who presented to our emergency department complaining of severe pain in the left inguinal area and scrotum. The acute painful swelling started suddenly, without any obvious cause. The initial diagnosis was incarcerated inguinal hernia which was reduced with difficulty. Five days later, the patient still experienced mild pain during palpation and he was operated on. During the operation, a large lower Spigelian hernia was revealed and reconstructed.ConclusionAlthough Spigelian hernias are rare in children and difficult to diagnose, physicians should be aware of them and include them in the differential diagnosis.

Appendicular abscess with appendicolith in a Spigelian hernia masquerading caecal volvulus—A case report

“…Unusually low Spigelian hernias mimicking inguinal hernias have also been reported but this is more common in children due to a congenital defect. 3 It is not an unusual phenomenon for the Spigelian hernias to remain undiagnosed even after imaging. In this case the CT revealed a possible caecal volvulus and the examination was not diagnostic either as there was no positive cough impulse and the lump was not reducible.…”

Undescended Testis Accompanying Congenital Spigelian Hernia: Is It a Reason, a Result, or a New Syndrome?

“…2,4,[6][7][8][9][10][11][12][13][14][15][16][17][18] However, 16 spontaneous SH cases not accompanied by UT (cases which develop following trauma and surgery were excluded) have been determined from 1955 to the present. [19][20][21][22][23][24][25][26][27][28][29][30][31] In two previous reports, Moles Morenilla et al 5 and Durham and Ricketts 6 reported the rate of UT cases accompanied by SH as 48.4 and 75%, respectively. In a literature search of the current study, this rate was determined to be 60%.…”

“…SH may be confused with an inguinal hernia, especially in low SH cases. 31 In the literature, various theories have been suggested for the etiology of SHs. The first of them is the "vascular theory," based on anatomy.…”

Laparoscopic Transabdominal Preperitoneal Repair of Spigelian Hernia—Closure of the Fascial Defect Is Not Necessary

“…The authors are aware that SHs below this zone have been reported but are extremely rare. 37 Such hernias should be differentiated from direct inguinal or supravesical hernias. Had we encountered a ''lower'' SH, we would still adopt the same technique described above, but we would recommend taking extra care when creating the peritoneal flap inferiorly to ensure that dissection and mesh fixation do not result in a nerve injury.…”