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ABDOMINAL IMAGING Table of Contents   
Year : 2004  |  Volume : 14  |  Issue : 1  |  Page : 43-44
Case report : Spigelian hernia


Dept. of Radiology, S.S.G. Hospital, Baroda, India

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Keywords: Spigelian hernia, US, CT

How to cite this article:
Raninga S, Bhatnagar P, Dabi P, Shah S. Case report : Spigelian hernia. Indian J Radiol Imaging 2004;14:43-4

How to cite this URL:
Raninga S, Bhatnagar P, Dabi P, Shah S. Case report : Spigelian hernia. Indian J Radiol Imaging [serial online] 2004 [cited 2019 Nov 19];14:43-4. Available from: http://www.ijri.org/text.asp?2004/14/1/43/28553

   Introduction Top

"A hernia is the protrusion of a viscus / part of viscus through an abnormal opening in the wall of its containing cavity [1]" Here we are presenting a case of  Spigelia More Detailsn hernia-an interparietal Hernia-an example of rare external abdominal wall hernia. One thousand cases have been reported in the literature [2]


   Case Report Top


A 74 year old man presented with history of constant dragging type of abdominal pain and lump in right lower part of abdomen for last six months. No history of vomiting or bowel disturbances was noted. On examination a soft reducible swelling was noted in the right lower quadrant of abdomen below the umbilicus and lateral to the rectus muscle. Ultrasonography revealed superficially located small bowel loops in the right iliac fossa. The bowel loops appeared normal in caliber and showed normal peristalsis. CT scan was done by giving 2% Trazogastro (750ml) orally. Axial scans show herniation of terminal ileum and caecum with peritoneal fat in the interparietal region between external oblique aponeurosis and internal oblique [Figure - 1]. A wide defect was seen in the tranversus abdominis fascia (also known as Spigelian fascia) and internal oblique muscle just below the umbilicus at the junction of arcuate and semilunar lines or right side [Figure - 2]. There was no evidence of obstruction or strangulation of bowel loops seen.


   Discussion Top


Spigelian hernia is a type of external abdominal wall hernia-a variety of interparietal hernia, where hernial sac passes between the layers of the anterior abdominal wall) [1] It represents only two percent of the anterior abdominal wall hernias [2]. Right to left ratio is 1.6:1 [2]. "Spigelian hernia occurs through a defect in the spigelian fascia which is the aponeurosis of the transverses abdominis. The fascia is weakest and widest at the junction of semilunar and arcuate line below the umbilicus at the lateral margin of rectus sheath [3]. The defect and hernial sac are usually small and less than two cm in size. The hernial sac is usually empty, but occasionally large and may contain small or large bowel, omentum and even a part of the stomach wall [2] Twenty percentage of the patient present with strangulation.

Imaging features include bowel loops outside the confinement of the peritoneal cavity on tangential views of plain xray abdomen and barium studies [2];[4].:USG shows break in the echogenic shadow of the semilunar line: the fascial defect with the hernial sac and the content passing through the defect in the spigelian fascia and lying in the subcutaneous or interstitial plane [2]. CT scan shows a defect at the level of linea semilunaris where it is crossed by the Arcuate line just inferior to the level of umbilicus. The sac dissects laterally and the most common type passes through the transverses and internal oblique aponeurosis and spreading out in the interstitial layer deep to the external oblique aponeurosis. Because of small size of the fascial defect the hernia frequently strangulates. The less common type includes the hernial sac in the interstitial layer between the transverses abdominis aponeurosis and the internal oblique muscle. In the least common type the hernial sac liesin the subcutaneous tissue. Treatment of the spigelian hernia is surgical repair of the fascial defect [5].

 
   References Top

1.Charles v. Mann. Hernia; umbilicus; Anterior abdominal wall. In:Bailey and Love's Short practice of surgery. Twenty second edition: CHAPMA AND HALL, London (1995). 55: 897:898.   Back to cited text no. 1    
2.Jack Abrahamson. Hernias. In: Maingot's Abdominal operations. Tenth edition: Appleton and Lange (1997), 14: 544- 546.   Back to cited text no. 2    
3.Dennis M. Balfe, Ernesto P. Molmenti and Harold F. Bennett. Normal abdominal and pelvic anatomy. In Computed tomography with mri correlation. Third edition; Lippincort-Raven publishers, Philadelphia, Newyork. 10:573-575.   Back to cited text no. 3    
4.Gaary G. Ghahremani. Aabdominal and pelvic hernias. In: Textbook of Gastrointestinal radiology (Gore/Levine / Lawfer): W. B. Saunder company (1994), 134: 2392-2393.   Back to cited text no. 4    
5.Robert E. Koehler, David S, Memel, Robert J. Stanley. GI Tract. In: Computed body Tomography with mri correlation: Thirdedition: Lippincort-Raven publishers. Philadelphaia, Newyork. 11:672.  Back to cited text no. 5    

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S Raninga
81, Shantinagar, Tarsali Road, Vadodara-390009
India
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[Figure - 1], [Figure - 2]



 

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    Introduction
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