What is Spigelian Hernia?
Spigelian Hernia or Lateral Ventral Hernia is a rare type of hernia that develops through the spigelian fascia. This is a layer between the rectus abdominis muscle and the lateral semi-lunar line. It is also defined as a protrusion of peritoneal fat or sac of an organ which has a congenital defect or a weakness in the spigelian fascia. It is mostly seen at or below the linea arcuata, probably because of a lack of posterior rectus sheath. It represents approximately 1-2% of all hernias and women are mostly affected and it is more likely to occur after the age of 50. Spigelian hernia doesn’t show any outward signs like swelling because it penetrates between the muscles of the abdominal wall. This type of hernia is usually small so it’s very difficult to diagnose. Because of its size compared to other hernias, there is a possible risk of strangulation. Predisposing factors that can cause spigelian hernia are increased intra-abdominal pressure, obesity, and trauma.
Source - sciencephoto.com
Location and Anatomy of Spigelian Hernia
Picture 2 – Different types of hernia
The location of Spigelian hernia is in the lateral edge of the rectus muscle and semi-lunar line, or below the level of the umbilicus. Spigelian hernia iappears through the spigelian fascia, which is the aponeurotic layer, layers of flat broad tendons that join the muscles, and is located between the rectus abdominis muscle (also known as “six pack”) and the semi-lunar line, a curved line on either side of rectus abdominis.
Diagram of Spigelian Hernia
This picture shows the common location of spigelian hernia inside the body.
Spigelian Hernia anatomy and location
What are Symptoms of Spigelian Hernia?
- Localized pain that comes and goes on a repetitive basis.
- Bowel obstruction (an obstruction in the intestines), preventing the normal transit of products of digestion.
- Nausea and vomiting, if there is a presence of bowel obstruction.
These are the general signs of spigelian hernia. This rare type of hernia is usually small and doesn’t show any outward signs, so it’s very difficult to determine its presence. The size of this hernia increases the risk for strangulation, therefore it’s essential that it is treated immediately once it’s detected and confirmed.
Spigelian Hernia, Causes
Spigelian hernias usually occur in patients with:
1. Increased intra-abdominal pressure in situations such as:
- Heavy labor in women can cause pressure in the abdominal area that might result in having spigelian hernia.
- People who develop urinary retention. This is characterized by having a poor, intermittent flow or a sense of incomplete voiding.
- Severe coughing or severe vomiting
- COPD or Chronic Obstructive Pulmonary Disease. COPD is a disease in the lungs in which the airways became narrowed, normally due to tobacco smoking which then triggers the inflammatory response in the lung.
2. Multiparous women, who give birth to 2 or more offspring, and patients with recent significant weight loss. Clinical findings include focal tenderness or a mass along the linea semilunaris leading to bowel incarceration and strangulation which are common effects that result from spigelian hernia.
3. Obesity is a medical condition where there is excess body fat in the body. People that are obese carry extra weight and their muscles are often unable to handle this extra weight which increases the chances of the person having a hernia. A patient that is obese will have difficulty in determining the location of a hernia, as well as a more difficult recovery after surgery.
Spigelian Hernia Diagnosis
- CT scan or Computed Tomography is considered the most reliable technique to verify the diagnosis. A CT scan uses special x-ray equipment that produces multiple images with different dimensions. It helps to identify abnormalities such as tumors and hernias inside the body.
- Ultrasound is recommended for detecting any presence of masses in the abdomen. Ultrasound is a procedure that uses high frequency sound waves to visualize internal organs and produces images of the body.
- MRI or Magnetic Resonance Imaging is a medical imaging technique that visualizes the internal organs. MRI can produce a good contrast between the different soft tissues of the body that is really helpful in determining any abnormalities.
- Ultrasonography is used for visualizing subcutaneous body structures such as tendons, muscles, joints, and internal organs.
These diagnostic exams can help doctors to detect any unrecognized cases of spigelian hernia. They can show any defect or abnormalities along the spigelian line in the lower abdomen, locate the presence of hernia sac, show how small the obstruction is and if strangulation is present.
Spigelian Hernia Treatment
There is no specific medical treatment for spigelian hernia. Because of the risk of strangulation, most doctors recommend surgery. During the surgical procedure the hernia is repaired or removed and the abdominal wall is strengthened with surgical mesh. This is a woven fabric that helps to strengthen tissues, to treat surgical wounds and provides support to organs. Surgical mesh also prevents the hernia from returning.
Edited and proofreaded by Jean on 30/8/2012.