title: A differential diagnosis in chronic lower abdominal pain.
abstract: BACKGROUND
  Spigelian hernias represent 0.12-2.4% of all abdominal wall hernias. Its diagnosis is elusive and requires a high level of conjecture given the disease rarity, vague associated abdominal complaints and frequent lack of consistent physical findings.
  
  
  METHODS
  A 60-year-old woman presented with a history of chronic pain in the left lower side of the abdomen. The patient was treated for several diseases with no relief of symptoms. Abdominal ultrasound showed a Spigelian hernia in the lower left abdomen and surgery was scheduled for treatment.
  
  
  CONCLUSIONS
  A SH is generally an inter-parietal hernia, meaning that the pre-peritoneal fat and the hernia sac penetrate the trasnversus abdominis and internal oblique muscles but remain behind the external oblique aponeurosis. In most of the patients the lack of clinical signs demands radiological investigation. That's the importance of the high grade of suspicious of the disease during the physical exam. The surgical repair is necessary due to the high risk of incarceration-related complications which can occur in up to 21% of cases.
  
  
  CONCLUSIONS
  It's important to think in the Spigelian hernia as cause of lower abdominal pain to prompt indicate surgical repair and provide the patient's symptom relief. Also the type of repair is dependent on the surgeon's choice and also the means available in each center.
authors.affiliation: General Surgery Medical Resident, Getúlio Vargas' University Hospital, Manaus, Amazonas, Brazil.
authors.forename: Marcos Duarte
authors.initials: MD
authors.lastname: Siosaki
authors.forename: Márcia Maria Hagge Coelho
authors.initials: MM
authors.lastname: Costa
authors.forename: Higino Felipe
authors.initials: HF
authors.lastname: Figueiredo
authors.forename: Messias Froes
authors.initials: MF
authors.lastname: da Silva Junior
authors.forename: Rubem Alves
authors.initials: RA
authors.lastname: da Silva Junior