title: Appendicular abscess with appendicolith in a Spigelian hernia masquerading caecal volvulus-A case report.
abstract: BACKGROUND
  Spigelian hernias are rare hernias of the anterior abdominal wall named after Adrian van den Spiegel, the anatomist who first described them in the 16th century. They represent around 2% of all hernias.
  
  
  METHODS
  We present an 83-year-old female with one week history of a painful right iliac fossa swelling, her examination revealed a tender lump with no cough impulse and non-reducible and her computed tomography (CT) scan showed a mass anterior to ileocaecal valve suggestive of a caecal volvulus. Intra-operative the finding was a Spigelian hernia containing an appendicular abscess and an appendicolith.
  
  
  CONCLUSIONS
  The diagnosis of Spigelian hernias represents a challenge for the surgeons principally due to their rarity but also due to their anatomy and the variety of their contents. Searching the literature we found many different intra-abdominal structures presenting within a Spigelian hernia but we did not encounter a case similar to this.
  
  
  CONCLUSIONS
  Clinicians need to be aware of these hernias when dealing with lower abdominal swellings and have a high index of suspicion even in the presence of negative clinical and CT findings.
authors: Department of Emergency Medicine, North Middlesex University Hospital, London N18 1QX, UK.
authors: G A
authors: GA
authors: Demetriou
authors: M S
authors: MS
authors: Nair
authors: Y
authors: Y
authors: Al-Abed
authors: N
authors: N
authors: Alobaid
authors: H
authors: H
authors: Safar-Aly
authors: A
authors: A
authors: Athow