[Strangulated intestinal Spigelian hernia]

Spigelian hernia, an uncommon hernia of the anterior abdominal wall, has serious complications in a high percentage of cases. The diagnosis is often difficult because the symptoms can be insidious or simulate those of more classical lower quadrant abdominal diseases. Furthermore, the clinical findings are often nonspecific. We report a case of Spigelian hernia complicated by acute strangulation diagnosed by ultrasound. The anatomic features and the physiopathology are reviewed and illustrated by another typical case diagnosed by CT. CT is superior to sonography in showing the defect of the abdominal wall, in identifying the contents of the hernial sac and in discovering abnormalities in other areas of the abdomen. Sonography also generally appears adequate in showing a parietal defect. We therefore recommend systematic ultrasonographic examination of the abdominal wall in all doubtful cases of undiagnosed abdominal pain with vague gastro-intestinal symptoms.