Spigelian hernia, also known as hernia spiegeli, hernia spigeli or lateral ventral hernia, is a type of abdominal hernia along the Spigelian line, between the rectus abdominis muscle and the semilunar line, resulting in herniation between the muscles of the abdominal wall.
They are rare and account for ~1% (range 0.1-2%) of ventral hernias 2-3. The incidence is thought to peak at around the 4th to 7th decades.
There may be a slightly increased female predilection with a male to female ratio is 1:1.18 3.
They may be congenital or acquired.
The hernial orifice of a Spigelian hernia is usually located along the semilunar line (Spigelian line) through the transversus abdominis aponeurosis (Spigelian fascia), close to the level of the arcuate line.
The majority of Spigelian hernias are found in a transverse band lying 0-6 cm cranial to a line running between both anterior superior iliac spines referred to as the Spigelian hernia belt.
The diagnosis of a Spigelian hernia at times presents greater challenge than its treatment. The clinical presentation varies, depending on the contents of the hernial sac and the degree and type of herniation.
The pain, which is the most common symptom, varies and there is no typical pain of a Spigelian hernia.
Findings to facilitate diagnosis are palpable hernia and a palpable hernial orifice.
Ultrasound can be recommended for verification of the diagnosis in both palpable and nonpalpable spigelian hernia.
The hernial orifice and sac can be well demonstrated by computed tomography, which gives more detailed information on the contents of the sac than does ultrasonic scanning.
Spigelian Hernia Symptoms
The majority of types of hernia are located subcutaneously beneath the fat layers, so the presence might be felt as swelling that is abnormal.
Now, this is not the case with a spigelian hernia. Identified as “interparietal hernia”, it is found inside the muscles of the walls of the abdomen.
Since it is a hernia that is sub-muscular, there is not any external swelling sign or bump with this type of hernia. As well, this kind of hernia is normally very tiny, adding to the difficulty in identifying.
The common indicators of this type of hernia are intermittent mass as well as abdominal discomfort.
Pain is a noticeable sign in the actual location and comes and goes on a repeated basis. After the start of painful symptoms of a hernia, the individual experiences low or dull degree of pain in the immediate area.
This type of hernia is small, and the external soft tissue mass or lump may be felt by the individual, who has little fat in the area that is affecting the abdomen.
In different individuals, decrease and functioning of the bowel and signs of obstruction bowel are observed and this tends to remain for more than only one day.
When a physician believes that an individual has this type of hernia, emphasis is given in the abdomen “linea arcuata”. It is taken for granted that the deficiency of “posterior rectus sheath” adds to the probability for increase of spigelian hernia in the linea arcutata portion. The physician will scrutinize the abdomen for the incidence of any lumps that are soft.
Because of the lack of major spigelian hernia symptoms, this medical problem is extremely hard to diagnose. In many cases, it stays concealed for a lengthy period of time.
A good medical exam is done and imaging tests are also done to eliminate other health conditions. Spigelian hernia is confirmed based on CT scan results.
Spigelian Hernia Causes
This type of hernia normally is caused by pressure intra-abdominally pushing out a portion of an abdominal organ into the abdominal muscle layers.
This type hernia is also known as “spontaneous” hernias since they often are created suddenly after trauma or injury to this abdomen area.
Chronic coughing, obesity as well as heavy-lifting as well as other factors cause this type of hernia to develop.
These hernias also may be the result of an inborn defect of connecting tissue, post-surgery infection, pregnancy, abdominal fluid as well as straining during bowel movement or urination.
Heredity is another issue in the chance of an individual developing this type of hernia. The lower part of the wall of the abdomen can weaken as conditions get worse due to time passing and the pressures of other activities.
Surgery is usually needed to repair this type of hernia, since it is prone to strangulation.
Conventional or laparoscopic surgery might be carried out to put any organs that were displaced back in correct place once the contents are detached from the hernia for suturing.
The abdominal wall that is injured is toughened with a surgical mesh in order to stop any recurrence. If this mesh is not in place, the hernia will be more likely to return.
This repair with mesh is a basic process that is relied upon highly. The individual’s recovery time is relatively short – around two weeks – and is normally without incident following either method.
The laparoscopic method is usually favored in order to minimize any chances of infection as well as reduce the stay in the hospital.
A post-surgery follow-up exam with the attending surgeon is common in order to exclude any complications so that normal activities may resume.