Spigelian herniae: presentation, diagnosis and treatment.
A personal series of 19 patients (8 males), mean age 62.4 years (range 21-83 years) with a spigelian hernia [right-sided in eight patients (42.1%)] is presented. The defect was confirmed in 18 patients undergoing surgery, extending between the internal and external oblique layers in 15 of those 18 patients (83.3%) and passing through the external oblique layer in three of the 18 (16.7%). Four uncommon variants were encountered in these 18 patients. The sac was empty in six (33.3%), contained small bowel in six (33.3%), greater omentum in five (27.8%), caecum in one (5.6%) and sigmoid colon in one (5.6%). Four of 19 patients (21.1%) presented acutely with a tender irreducible mass. Thirteen of 19 patients (68.4%) presented electively. All had a palpable swelling which was reducible in 11 of these 13 (84.6%). Local pain and tenderness was inconstant. A spigelian hernia was an incidental finding in two of the 19 patients (10.5%). In only nine out of 17 patients (52.9%) was the diagnosis suspected pre-operatively, and treatment was frequently delayed. Predisposing factors were present in 15 of the 19 patients (78.9%).
Artioukh
D Y
DY
Department of Surgery, Whiston Hospital, Prescot, Merseyside, UK.
Walker
S J
SJ
D000009:Abdominal Muscles / Q000473:pathology; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002432:Cecum / Q000473:pathology; D012809:Colon, Sigmoid / Q000473:pathology; D005260:Female; D006555:Hernia, Ventral / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery / Q000628:therapy; D006801:Humans; D007421:Intestine, Small / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009852:Omentum / Q000473:pathology; D012307:Risk Factors; D015996:Survival Rate; D013537:Sutures