Spigelian hernia: a diagnostic dilemma and laparoscopic management

Area of Science:

• Abdominal Surgery
• Gastroenterology
• Surgical Innovation

Background:

• Spigelian hernias, or lateral ventral hernias, are uncommon and often present as intraparietal hernias, making clinical diagnosis difficult.
• Their small neck size increases the risk of strangulation, necessitating accurate and timely diagnosis.
• Laparoscopic techniques are increasingly applied to hernia repair, offering potential benefits in morbidity and recovery time.

Purpose of the Study:

• To report a rare case of a large Spigelian hernia that presented a diagnostic challenge.
• To illustrate the diagnostic process and successful management of a complex Spigelian hernia.
• To highlight the utility of advanced imaging and laparoscopic repair in Spigelian hernia cases.

Main Methods:

• A case study of a patient with a large Spigelian hernia is presented.
• Diagnostic workup involved clinical examination, ultrasound, and computed tomography (CT) scan.
• Surgical management was performed using laparoscopic intraperitoneal onlay mesh repair.

Main Results:

• The Spigelian hernia was large and initially posed a diagnostic dilemma due to non-specific symptoms and ultrasound findings.
• A CT scan was crucial for confirming the diagnosis.
• The patient underwent successful laparoscopic repair with good outcomes.

Conclusions:

• Spigelian hernias, despite their rarity, require a high index of suspicion for diagnosis.
• CT scanning is a valuable tool for confirming Spigelian hernias when clinical and ultrasound findings are equivocal.
• Laparoscopic intraperitoneal onlay mesh repair is an effective and safe treatment option for large Spigelian hernias.