title: Incarcerated Spigelian hernia in morbidly obese patients: the role of intraoperative ultrasonography for hernia localization.
abstract: BACKGROUND
  Spigelian hernias are uncommon and their diagnosis can be difficult. Ultrasonography is, as a rule helpful in making the diagnosis, but extensive exploration is sometimes needed to locate the defect.
  
  
  METHODS
  Two patients are described in whom the diagnosis was made preoperatively by ultrasonography, but intraoperative location of the hernias proved extremely difficult because of the patients' obesity.
  
  
  RESULTS
  In the first patient, the hernia was located by means of intraoperatively performed ultrasonography. In the second patient, ultrasonography was combined with intraoperatively insufflated pneumoperitoneum and this proved successful in identifying the position of the sac.
  
  
  CONCLUSIONS
  Intraoperative ultrasonography is a valid option for accurate localization of Spigelian hernias, especially in obese patients; extensive intraoperative dissection, distortion of tissue planes, and associated morbidity risks may be avoided.
authors.affiliation: Department of Emergency Surgery, Military Medical Academy, Sofia, Bulgaria.
authors.forename: J E
authors.initials: JE
authors.lastname: Losanoff
authors.forename: K T
authors.initials: KT
authors.lastname: Kjossev
mesh_terms: D000328:Adult; D006555:Hernia, Ventral / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D009767:Obesity, Morbid / Q000150:complications*; D011028:Pneumoperitoneum, Artificial; D014463:Ultrasonography