A
Spigelian hernia (or
lateral ventral hernia) is a
herniaA hernia is protrusion of an organ or the muscular wall of an organ through the cavity that normally contains it. A hiatal hernia occurs when the stomach protrudes upwards into the mediastinum through the esophageal opening in the diaphragm.-Pathophysiology:...
through the spigelian
fasciaFascia , pl. fas·ci·ae , adj. fascial is the soft tissue component of the connective tissue system that permeates the human body. It interpenetrates and surrounds muscles, bones, organs, nerves, blood vessels and other structures...
, which is the aponeurotic layer between the
rectus abdominis muscleThe rectus abdominis muscle is a paired muscle running vertically on each side of the anterior wall of the human abdomen . There are two parallel muscles, separated by a midline band of connective tissue called the linea alba...
medially, and the
semilunar lineThe linea semilunaris is a curved tendinous line placed one on either side of the rectus abdominis.Each corresponds with the lateral border of the rectus, extends from the cartilage of the ninth rib to the pubic tubercle, and is formed by the aponeurosis of the internal oblique at its line of...
laterally. These hernias almost always develop at or below the
linea arcuataThe arcuate line of the abdomen is a horizontal line that demarcates the lower limit of the posterior layer of the rectus sheath. It is also where the inferior epigastric vessels perforates the rectus abdominus....
, probably because of the lack of posterior rectus sheath. These are generally interparietal hernias, meaning that they do not lie below the subcutaneous fat but penetrate between the muscles of the abdominal wall; therefore, there is often no notable swelling.
Spigelian hernias are usually small and therefore risk of
strangulationStrangulating is the process of constricting blood vessels which cause arrest in the flow of blood to a tissue....
is high.
A
Spigelian hernia (or
lateral ventral hernia) is a
herniaA hernia is protrusion of an organ or the muscular wall of an organ through the cavity that normally contains it. A hiatal hernia occurs when the stomach protrudes upwards into the mediastinum through the esophageal opening in the diaphragm.-Pathophysiology:...
through the spigelian
fasciaFascia , pl. fas·ci·ae , adj. fascial is the soft tissue component of the connective tissue system that permeates the human body. It interpenetrates and surrounds muscles, bones, organs, nerves, blood vessels and other structures...
, which is the aponeurotic layer between the
rectus abdominis muscleThe rectus abdominis muscle is a paired muscle running vertically on each side of the anterior wall of the human abdomen . There are two parallel muscles, separated by a midline band of connective tissue called the linea alba...
medially, and the
semilunar lineThe linea semilunaris is a curved tendinous line placed one on either side of the rectus abdominis.Each corresponds with the lateral border of the rectus, extends from the cartilage of the ninth rib to the pubic tubercle, and is formed by the aponeurosis of the internal oblique at its line of...
laterally. These hernias almost always develop at or below the
linea arcuataThe arcuate line of the abdomen is a horizontal line that demarcates the lower limit of the posterior layer of the rectus sheath. It is also where the inferior epigastric vessels perforates the rectus abdominus....
, probably because of the lack of posterior rectus sheath. These are generally interparietal hernias, meaning that they do not lie below the subcutaneous fat but penetrate between the muscles of the abdominal wall; therefore, there is often no notable swelling.
Spigelian hernias are usually small and therefore risk of
strangulationStrangulating is the process of constricting blood vessels which cause arrest in the flow of blood to a tissue....
is high. Most occur on the right side. Most develop around age 50 (4th-7th decade of life). Compared to other types of hernias they are rare.
Symptoms and diagnosis
Patients typically present with either an intermittent mass, localized pain, or signs of
bowel obstructionBowel obstruction is a mechanical or functional obstruction of the intestines, preventing the normal transit of the products of digestion. It can occur at any level distal to the duodenum of the small intestine and is a medical emergency...
. Ultrasonography or a CT scan can establish the diagnosis, although CT scan provides the greatest sensitivity and specificity.
Treatment
These hernias should be repaired because of the high risk of strangulation; fortunately, surgery is straight-forward, with only larger defects requiring a mesh prosthesis.Varied Spigelian hernia mesh repair techniques have been described, although evidence suggests laparoscopy results in less morbidity and shorter hospitalization compared with open procedures. Mesh-free laparoscopic suture repair is feasible and safe. This novel uncomplicated approach to small Spigelian hernias combines the benefits of laparoscopic localization, reduction, and closure without the morbidity and cost associated with foreign material.
Eponym
Adriaan van den SpiegelAdriaan van den Spiegel, name sometimes written as Adrianus Spigelius was a Flemish anatomist who was born in Brussels. For much of his career he practiced medicine in Padua, and is considered one of the great physicians associated with that city...
, a
surgeonIn medicine, a surgeon is a person who performs surgery. Surgery is a broad category of invasive medical treatment that involves the cutting of a body, whether human or animal, for a specific reason such to remove a diseased organ or to repair a tear or breakage. Surgeons may be medical doctors,...
-anatomist born in
BrusselsBrussels , officially the Brussels Region or Brussels-Capital Region , is the de facto capital city of the European Union and the largest urban area in Belgium...
, described this hernia. The first publication was in 1645, twenty years after Spiegel's death.