title: Low Spigelian hernia in a 6-year-old boy presenting as an incarcerated inguinal hernia: a case report.
abstract: BACKGROUND
  Lower Spigelian hernia is a very rare entity. The clinical findings are similar to those of inguinal hernias and in many cases may be misdiagnosed. In the literature, only a few references to this entity have been reported in children. To the best of our knowledge, this is the first case report of a lower Spigelian hernia in a child who presented with an acute painful scrotum.
  
  
  METHODS
  We discuss the case of a 6-year-old Greek boy who presented to our emergency department complaining of severe pain in the left inguinal area and scrotum. The acute painful swelling started suddenly, without any obvious cause. The initial diagnosis was incarcerated inguinal hernia which was reduced with difficulty. Five days later, the patient still experienced mild pain during palpation and he was operated on. During the operation, a large lower Spigelian hernia was revealed and reconstructed.
  
  
  CONCLUSIONS
  Although Spigelian hernias are rare in children and difficult to diagnose, physicians should be aware of them and include them in the differential diagnosis.
authors.affiliation: First Department of Surgery, Piraeus General Hospital "Tzaneio", Piraeus-Athens, Greece. d_filippou@hotmail.com.
authors.forename: Efstratios
authors.initials: E
authors.lastname: Christianakis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Paschalidis
authors.forename: Georgios
authors.initials: G
authors.lastname: Filippou
authors.forename: Spiros
authors.initials: S
authors.lastname: Rizos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Smailis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Filippou