Spigelian Hernia in a 14-Year-Old Girl: A Case Report and Review of the Literature

Abstract

Spigelian hernia (SH) is a surgical rarity in children, which occurs through slit-like defects in the anterior abdominal wall adjacent to the semilunar line, the convexity lateral line which joins the nine ribs to the pubic tubercle and signs the limit between the muscular and aponeurotic portion of transversus abdominis muscle. As there are no specific symptoms and signs, the diagnosis is difficult, especially in children. We report a case of SH that comes to our observation: a 14-year-old girl presented recurrent abdominal pain associated to intermittent palpable mass in the paraumbilical region. Starting from our case report, we review the literature of pediatric SH from 2000 to 2013 and we describe the anatomy, etiology, clinical presentation, instrumental diagnosis, and surgical technique of pediatric SH.

Large Strangulated Spigelian Hernia: Management of an Uncommon Presentation of Abdominal Hernias in Central Uganda

“…In 24% of the cases, the strangulation is a major complication of Spigelian hernia as seen in our case report [5]. The contents of the sac are mostly the omentum but can also include the small intestine, colon, stomach, gallbladder, Meckel's diverticulum, appendix, ovaries, and testes [8]. The contents of the sac in our case were inflamed jejunum, obstructed with adhesions.…”

“…In Spigelian hernia, mesh repair associated with laparoscopy correction is the best procedure in developed countries [8], but in our area, we went ahead with open surgery using a Rutherford-Morrison incision for easy access to the defect and good exposure as the hernia was big and strangulated. We corrected the defect using a gold standard technique, mesh repair and fixed the mesh under layers using Nylon 0, from the lower part of the inguinal ligament and up to the sheath of the muscles (Figure 5).…”

Outcome of Orchidopexy in Spigelian Hernia-Undescended Testis Syndrome

“…The cause can be acquired or congenital, and as in the pediatric group, the causes remain unclear, and many hypotheses have been put forward. For example, alterations in the structure of the transverses abdominis and internal oblique muscles with the developmental aberration of abdominal muscle and muscular paralysis [6,7].…”

“…Rushfeldt et al attributed the failure to develop a gubernaculum to arrested (intra-abdominal) testis development, failing to descend to the normal position in the scrotum [11]. The average age for congenital SH presentation is 4.52 years but ranges from newborns to 17-year-olds [7]. A baby with reducible anterior abdominal wall swelling and UDT should increase the clinician's suspicion [5].…”

Spigelian hernia in gynaecology

“…Spigelian hernia is rare, representing 1 to 2% of all abdominal hernias. It occurs mostly in women over 60 years of age [ 6 ] but can occur at a younger age [ 7 ], even in neonates [ 8 , 9 ]. The aetiology is unclear; obesity with rapid weight loss, multiple pregnancies and chronic obstructive pulmonary disease (COPD) are considered predisposing factors.…”