Small bowel herniation through a spigelian defect within 48 hours after laparoscopy

Spigelian hernia is extremely rare, with an incidence of 1% to 2% of all abdominal hernias. Herein we report the case of a woman with a spigelian hernia occurring within 48 hours after laparoscopic salpingo-oophorectomy. The patient had abdominal pain, nausea, and abdominal mass. An abdominal series revealed multiple dilatations of the small bowel, compatible with a small bowel obstruction, and computed tomography demonstrated a right-sided abdominal hernia with small bowel obstruction. The diagnosis of spigelian hernia was made during a second surgery. The bowel was reduced and the fascial defect repaired. The postoperative recovery was uneventful. It would seem that pneumoperitoneum during laparoscopic surgery and the trauma of trocar insertion can trigger development of a spigelian hernia.