ICG-guided bowel preservation during emergency TAPP repair for incarcerated Spigelian hernia: a case report

Spigelian hernia (SpH) is a rare abdominal wall hernia associated with a significant risk of incarceration. We report the case of an incarcerated SpH that was successfully managed with emergency laparoscopic surgery. An 81-year-old female presented with acute abdominal pain. Contrast-enhanced computed tomography revealed small bowel incarceration through a defect lateral to the left rectus abdominis muscle, with preserved blood flow. After unsuccessful manual reduction, emergency laparoscopic surgery was performed. The incarcerated bowel was reduced using a hydrostatic reduction technique with gentle traction. Serial indocyanine green fluorescence angiography demonstrated improving bowel perfusion, and bowel resection was avoided. The hernia was repaired via the transabdominal preperitoneal (TAPP) approach with defect closure. The postoperative course was uneventful, and no recurrence was observed during 3.5 years of follow-up. Emergency TAPP repair combined with serial indocyanine green-guided perfusion assessment may be a useful option for carefully selected cases of incarcerated SpH.