title: The syndrome of Spigelian hernia and cryptorchidism: a review of paediatric literature.
abstract: OBJECTIVE
  The purpose of this study is to present a summary of paediatric Spigelian hernia (SH) reported to date, and discuss possible aetiology of SH associated with ipsilateral ectopic testis (SH-ET).
  
  
  METHODS
  Search of PubMed, Medline, Embase, and CINAHL was performed using keywords "Spigelian hernia". The following were extracted from articles describing paediatric SH: demographics, site and contents of SH, comorbidities, proposed aetiology, presence of ipsilateral inguinal canal (IC) and gubernaculum (G).
  
  
  RESULTS
  There were 78 patients with 88 hernias (69 male, 19 female), including 55 male (19 left, 22 right, 7 bilateral) and 16 female (5 left, 5 right, 3 bilateral) nontraumatic SHs. In nontraumatic male SH, 29 hernias contained testis (10 left, 11 right, 4 bilateral), 15 did not, 10 had no data. Of 29 SH-EH, 15 were lacking IC and G, 3 were missing IC (no G data) and 2 had absent G (no IC data). The combination of SH and cryptorchidism is increasingly recognised as a distinct syndrome. However, there is controversy as to the pathogenic mechanism of this association. We hypothesise SH-ET develops because the G, and therefore IC and line of descent, become cranially 'mislocated' along the mammary line, which overlies the Spigelian fascia.
  
  
  CONCLUSIONS
  SH is rare in children. SH-ET may result by testicular descent to an ectopic site along the embryological mammary line.
authors: F. Douglas Stephens Surgical Research Laboratory, Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria, Australia, 3052; Department of Urology, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia, 3052. Electronic address: brendan.c.jones@gmail.com.
authors: Brendan C
authors: BC
authors: Jones
authors: F. Douglas Stephens Surgical Research Laboratory, Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria, Australia, 3052; Department of Urology, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia, 3052. Electronic address: john.hutson@rch.org.au.
authors: John M
authors: JM
authors: Hutson
mesh_terms: D002648:Child; D003456:Cryptorchidism / Q000150:complications*; D006555:Hernia, Ventral / Q000150:complications* / Q000151:congenital*; D006801:Humans; D008297:Male; D013577:Syndrome
keywords: Congenital; Cryptorchidism; Spigelian hernia