f Post graduate mcqs and discussion : SPIGELIAN HERNIA

Tuesday, March 27

SPIGELIAN HERNIA

 It is a type of interparietal hernia occurring at the level of arcuate line through spigelian point.

Hernial sac lies either deep to the internal oblique or between external and internal oblique muscles.

Fig: SPIGELIAN HERNIA


It is lateral ventral hernia through Spigelian fascia at any point along its line.

Semilunar line of Spigel is a line from pubic tubercle to tip of 9th costal cartilage.

It marks the lateral margin of the rectus sheath. Semicircular arcuate line (fold) of Douglas is lower end of posterior lamina of rectus sheath below the umbilicus and above the pubis.

Spigelian fascia is area between lateral border of the rectus muscle and external and internal oblique and transversus abdominis muscle.

Spigelian hernia can occur above or below  the umbilicus.

Below the umbilicus it occurs at the junction of linea semilunaris and linea semicircularis (wider and weaker point).
In Spigelian hernia, defect is formed by internal oblique and transversus abdominis muscle.

External oblique is outer to the hernial sac.


Clinical Features

Presents as a soft, reducible mass lateral to the rectus muscle and below the umbilicus, with impulse on coughing.

Strangulation is common in spigelian hernia.

Presence of precipitating factors like obesity, chronic cough, old age, multiple pregnancies.

Common in females after 50 years of age.


Differential Diagnosis

Abdominal wall lipoma.
Soft tissue sarcoma.
Abdominal wall haematoma.


Treatment


Through a lengthy transverse incision herniotomy and later closure of the defect layer by layer using nonabsorbable interrupted sutures.

But ideally mesh is required to cover the defect properly.

Laparoscopic dual mesh placement is also useful.