title: Left colon obstruction due to non-reducible Spigelian hernia of the right side. Report of a case and literature review.
abstract: OBJECTIVE
  Describe a rare case of intestinal obstruction due to sigmoid colon incarceration into a right Spigelian hernia and provide a literature review about its surgical management.
  
  
  METHODS
  An 88 year-old man presented with a 3-day history of right lower quadrant pain and abdominal distension. Clinical examination revealed a not reducible palpable mass on right side of the anterior abdominal wall. Computed tomography shown signs of intestinal obstruction and a Spigelian hernia of about 3 cm.
  
  
  RESULTS
  Sigmoid colon was incarcerated in the defect but no signs of intestinal ischemia was found during the surgical exploration. The hernia content was reduced and the defect was repaired with a polypropylene mesh placed in the pre-peritoneal space. Postoperative period was uneventful and the patient was discharged on the fourth postoperative day.
  
  
  CONCLUSIONS
  Spigelian hernia occurs through congenital or acquired defects in the Spigelian fascia at the level of the semicircular line. Clinical presentation depends on the size and the pattern of the hernia defect. In some cases, symptoms are no specific and uncommon findings have been reported so far. Preoperative establishment of the hernia content and the location of the sac is mandatory to plan a correct surgical strategy. Intestinal incarceration often occurs and suggests a prompt surgical exploration.
  
  
  CONCLUSIONS
  Colonic obstruction secondary to an incarcerated Spigelian hernia is a rare but dangerous occurrence. Surgical approach is selected based on patient's conditions and surgeon's expertise. In a non-contaminated surgical field, the use of prosthesis is recommended.
  
  
  BACKGROUND
  Intestinal obstruction, Mesh repair, Spigelian hernia.
authors.forename: Paolo
authors.initials: P
authors.lastname: Panaccio
authors.forename: Paolo
authors.initials: P
authors.lastname: Raimondi
authors.forename: Michele
authors.initials: M
authors.lastname: Fiordaliso
authors.forename: Antonio
authors.initials: A
authors.lastname: Dell'Osa
authors.forename: Roberto
authors.initials: R
authors.lastname: Cotellese
authors.forename: Paolo
authors.initials: P
authors.lastname: Innocenti
mesh_terms: D000006:Abdomen, Acute / Q000209:etiology; D000369:Aged, 80 and over; D000070606:Aponeurosis / Q000002:abnormalities; D004630:Emergencies; D006555:Hernia, Ventral / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D059685:Herniorrhaphy; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D008297:Male; D012810:Sigmoid Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D014057:Tomography, X-Ray Computed