"Bulb-like" sign: Small bowel closed loop obstruction in incarcerated Spigelian hernia

Area of Science:

• Abdominal Surgery
• Diagnostic Imaging
• Gastroenterology

Background:

• Spigelian hernia is a rare condition, accounting for about 0.1% of abdominal wall hernias.
• It occurs due to a defect in the Spigelian fascia, typically lateral to the rectus muscle.
• Clinical diagnosis can be challenging without a visible abdominal mass.

Observation:

• This report details a 64-year-old male with small bowel obstruction from an incarcerated Spigelian hernia.
• The condition was pre-operatively diagnosed using ultrasound and computed tomography (CT).
• Imaging demonstrated a closed-loop obstruction within the hernia.

Findings:

• Ultrasound and CT scans revealed a distinctive "bulb-like" appearance of the incarcerated Spigelian hernia.
• These imaging modalities were crucial for identifying the closed-loop obstruction.
• The findings highlight the diagnostic value of imaging in Spigelian hernia cases.

Implications:

• Accurate pre-operative diagnosis of Spigelian hernia is possible with advanced imaging techniques.
• Recognizing the "bulb-like" sign on ultrasound and CT can improve diagnostic accuracy.
• This case underscores the importance of imaging in managing rare hernias causing bowel obstruction.