Strangulated Epiploic Appendagitis in a Spigelian Hernia: A Rare Clinical Encounter

A Spigelian hernia (SH) is an uncommon abdominal wall hernia occurring along the semilunar line and is often difficult to diagnose due to its intermuscular location. The presence of an epiploic appendage within the hernial sac is extremely rare and may further complicate diagnosis, especially when associated with inflammation or strangulation. We report a case of a 37-year-old female presenting with persistent left lower quadrant abdominal pain, fever, and nausea. Clinical examination revealed localized tenderness, while laboratory findings demonstrated leukocytosis and elevated inflammatory markers. Ultrasound of the abdomen was inconclusive. Computed tomography (CT) demonstrated a fat-attenuating lesion with a hyperattenuating rim and surrounding inflammatory changes, herniating through the semilunar line, consistent with the diagnosis of epiploic appendagitis (EA) within an SH, which is a rare condition with an incidence of 8.8 per million patients. The patient underwent successful laparoscopic reduction and repair with an uneventful recovery.