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Spigelian hernias in infants: report of two cases
1Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa.
Insights
Spigelian hernias are rare in infants. This study reports two cases in female infants, with one possibly showing spontaneous closure, a phenomenon not previously documented in pediatric spigelian hernias.
Area of Science:
- Pediatric Surgery
- Abdominal Wall Defects
- Herniology
Background:
- Spigelian hernia is a rare ventral hernia type, infrequently diagnosed in pediatric patients.
- This condition involves protrusion through the spigelian fascia, typically lateral to the rectus abdominis muscle.
- Understanding its presentation and natural history in infants is crucial for appropriate management.
Observation:
- Two cases of left-sided spigelian hernias in female infants under one year are presented.
- One infant had an ovary within the hernia sac, requiring surgical repair at seven months.
- The second infant's hernia, diagnosed neonatally, presented alongside a congenital diaphragmatic hernia, with spontaneous reduction and resolution observed.
Findings:
- A literature review identified only eight prior cases of spigelian hernias in infants under one year.
- The second case is the first reported instance of a spigelian hernia potentially closing spontaneously in an infant.
- The presence of an ovary within the hernia sac highlights the diverse contents possible in pediatric spigelian hernias.
Implications:
- The findings suggest that spontaneous closure may be a possible outcome for pediatric spigelian hernias, warranting further investigation.
- This possibility could influence surgical decision-making, potentially avoiding unnecessary interventions in select cases.
- Further research into the natural history of spigelian hernias in infants is needed to confirm spontaneous closure and identify predictive factors.
Abstract:
Spigelian hernia, an uncommon but well-recognized ventral hernia, is rare in children. Two such cases are reported, both on the left side in female infants under 1 year of age. The first hernia, which was repaired when the infant was 7 months old, contained an ovary. Repair of the second hernia, which was diagnosed in the neonatal period, was delayed because of a congenital diaphragmatic hernia requiring urgent repair. The hernia reduced spontaneously and is no longer palpable, suggesting spontaneous closure. A literature review revealed only eight other cases of spigelian hernias occurring in infants less than 1 year of age. Spontaneous closure has not been recorded before.