Sonographic imaging of Spigelian hernias

Abstract

The aim of the workwas to present clinical material referring to rarely occurring abdominal cavity hernias in semilunar line – Spigelian hernias diagnosed with the help of ultrasound.Material and methodsIn the period from 1995 to 2001 785 anterior abdominal wall hernias were diagnosed including 11 Spigelian hernias (1.4%) diagnosed in 10 patients (7 women and 3 men) aged from 38 to 65 years old (average age 48). Eight patients complained of spastic pain in abdomen, in 5 of them it was accompanied by bloating and sometimes loud peristalsis. All the patients had been observing the mentioned symptoms from 2 to 5 years. Each of them had had colonoscopy and abdominal cavity ultrasound examination performed, some of them even three times. In 3 women with uterine fibroid the uterus was removed which did not eliminate the symptoms.The ultrasound examination of the abdominal integument was performed mainly with the use of linear transducers of the frequency of 7–12 MHz; in obese patients also convex transducers were used (3,5–6 MHz). Each examination of abdominal integument included the assessment of the following areas: linea alba from xiphoid process to pubic symphysis including umbilicus, both semilunar lines from costal margins to pubic bones, and also inguinal areas. Moreover, all types of postoperative scars were examined. Each hernia was assessed in terms of size (the greatest dimension), hernia sac contents, width of the ring and reducibility under the compression of the transducer. Moreover, cough test and Valsalva's maneuver were performed. Generally, the examination was performed in a standing position.ResultsIn 9 patients hernias were localized unilaterally, in one patient bilaterally. In 7 cases the hernia sac contained small bowel, in 2 cases the preperitoneal and omental fat, and in 2 cases preperitoneal fat only. Eight patients presenting with clinical symptoms underwent operative repair.ConclusionUltrasound examination is beneficial in confirming the diagnosis of Spigelian hernias especially in terms of proper, therapeutic decision-making.

Hernia de Spiegel como causa de obstrucción intestinal de íleon en una paciente anticoagulada por fibrilación auricular, abordaje laparoscópico. Reporte de caso.

“…Esta es la teoría que los autores consideramos que ha ocurrido con la paciente descrita, dado que tenía una cesárea previa, y la hernia que padecía se encontraba superior a dicha incisión, sin aparente relación con la misma. En esta serie una de sus pacientes fue una mujer histerectomizada en la que la hernia se encuentra lateral a la cicatriz, pudiendo explicarse también por esta teoría fisiopatológica, como ocurre en nuestro caso [10][11][12] .…”

“…En ella se puede observar el contenido herniario y la extensión exacta del orificio y del saco herniario. En este estudio, un 60 % de los casos contenían grasa preperitoneal, un 20 % contenían epiplón, un 74 % contenían intestino delgado y un 31 % intestino grueso 11,12 . En el caso presentado en este trabajo la TC fue fundamental, ya que se trataba de una hernia de gran tamaño y permitió conocer el contenido del saco herniario de cara a la cirugía.…”

Imaging of Hernias

“…Diastasis of the rectus abdominis muscle often predisposes to epigastric hernias and fatty hernia of the linea alba. Defects are usually small sized, and the content is almost always fat [8]. They have to be differentiated from other causes of epigastric pain.…”

“…A linear transducer (10-15 MHZ) is usually used for scanning; however, in obese patients, a curvilinear transducer (2-7 MHZ) is used. The use of color Doppler is helpful in the diagnosis of serious complications and incarceration and strangulation by checking the viability of the intestinal loops [8]. The second choice for diagnosis in modern imaging is computed tomography which displays excellent anatomy of the abdominal wall, especially with multidetector modern scanners; however, the risk of radiation makes it the second choice after ultrasound.…”

Špigelio Išvarža: Literatūros Apžvalga Ir Vilniaus Miesto Klinikinės Ligoninės Patirtis

“…Smereczyński ir kt. [7] duomenimis, pilvo sienos echoskopija gali būti naudojama kaip pirmo pasirinkimo diagnostinis tyrimas, kurį rekomenduojama atlikti pacientui stovint. Gali būti naudojamas Valsalve manevras arba kosulio testas.…”