Management of Traumatic Spigelian Hernia: A Case Report and Literature Review

Abstract

Traumatic abdominal wall hernias comprise less than 1% of all abdominal wall hernias. We present a 22-year-old male sustaining a traumatic Spigelian hernia resulting from striking a guardrail while snowboarding. In addition, the patient was found to have injuries to the serosa of the small bowel and mesentery, which were repaired during emergent surgery. A hybrid surgical approach was used to repair the defect using both laparoscopy and an incision over the abdominal wall defect.

Traumatic Spigelian Hernia Following Blunt Abdominal Trauma

“…Some common factors include multiparity, chronic cough, obesity, and comorbidities like diabetes mellitus, peripheral vascular disease, chronic obstructive pulmonary disease, stroke, and myocardial infarction [ 4 ].In contrast, traumatic Spigelian hernia appears acutely following trauma like handlebar injuries, falls from height, etc. [ 5 ]. Wood et al in 1988 attempted to classify TAWH into three types based on the mechanism of injury and size of the defect.…”

“…It tends to occur in the Spigelian belt, an imaginary 6 cm wide band above the inter-spinous line [ 7 ]. Notably, the posterior rectus sheath is absent in the lower half of the abdomen below the arcuate line [ 5 ]. Clinical features include the sudden appearance of a palpable mass following trauma.…”

“…Clinical features include the sudden appearance of a palpable mass following trauma. The overlying skin is intact although it may be associated with abrasion or ecchymosis [ 5 ]. It may be associated with bowel obstruction or strangulation.…”

“…Hernia, if not apparently visible, may be made more prominent with the Valsalva maneuver and while in a standing position. However, this may be difficult to do in trauma patients [ 5 ].…”