Spigelian Hernia

What is Spigelian hernia?

This is a hernia that develops through your spigelian fascia. The spigelian fascia is the layers of broad flat tendons that join the muscles. It is located between your semilunar line and your rectus abdominis muscle. The semilunar line is the curved line found on either side of your rectus abdominis muscles, which is located in the front of your body beginning at your pubic bone and ending at your sternum. It is also referred to as your “abs.” The spigelian hernia is also called the lateral ventral hernia. Most hernias thrive just below the layers of fat but with this particular hernia it is found between the muscles that are found in your abdominal wall.There is little outward appearance of swelling so this medical problem can go undetected for a long period of time. Both men and women can develop this type of hernia equally but women are seen more often for them. Sometimes a spigelian hernia is mistaken for other abdominal problems. This type of hernia is relatively rare and represents approximately one to two percent of all hernias. They will usually not develop until after the age of fifty. When it develops it is normally on the right side of your abdomen. The hernia was first described by surgeon-anatomist Adriaan van den Spiegel of Brussels. The first publication about this type of hernia came twenty years after his death in 1645.

Symptoms of Spigelian Hernia

With a spigelian hernia there are few symptoms to indicate that you have this hernia. One indicator is pain in the immediate area that reoccurs followed by a period of dull pain that is constant. Some may notice that they have a dull pain that lingers that may be interrupted with sharper pain when they lift something heavy, twist, or bends. Another indicator is a sudden decrease in the proper function of your bowels, especially if it lasts longer than a couple of days. If you are one that has little fat in your abdominal area you may notice a small protrusion and it is usually soft to the touch.Sometimes there is a change in your bowel movements such as changes in the color of the stool, constipation, or diarrhea. If there is bowel strangulation you may experience a lot of abdominal pain, vomiting, nausea, and changes to your stool.

Causes

The causes of this hernia are similar to all other types of hernias, which can include:

• Developing because of a weakening of your abdominal wall as you age
• Injury
• Prolonged times of physical stress
• Sporting activities
• Straining when you urinate or have a bowel movement
• Severe coughing
• Severe vomiting
• Pregnancy and heavy labor
• Inborn defect of connecting tissue
• Post-surgery infection
• Abdominal fluid
• Obesity

Sometimes heredity will factor in a person developing a spigelian hernia.

Diagnosis

When diagnosing a spigelian hernia it can take some time because of the vague symptoms. It may be a challenge to figure out what is causing your symptoms. They may also use a medical imaging study to look at your abdominal wall to see if there is a hernia there. The most reliable medical imaging method would be the CT scan.

Treatment

If this hernia is not treated it can do a lot of damage such as causing some type of obstruction in your color or if it develops in a location you experience bowel strangulation either can lead to the deterioration of both of these organs. Eventually complete failure of the organs can happen. The treatment that is most commonly used is to have surgery to repair the damage the spigelian hernia has caused.

Surgery

Surgery to have this problem corrected can be done using laparoscopic or conventional surgery. If possible the laparoscopic surgical method is chosen because it helps to minimize any chance of infection. It also reduces the time you have to remain in the hospital. With laparoscopic surgery the surgeon will make several small incisions in your abdomen in which to insert a tiny video camera. There will be other tiny instruments that are inserted in the small incisions to collect the hernia sac. The spigelian hernia will be pushed back into the abdominal cavity or repaired.The surgeon may use some type of mesh to reinforce your weakened abdominal walls but it all depends on how severe the damage is. If mesh is used as reinforcement this can help to decrease the opportunity for it to reoccur.If you suffer from bowel strangulation, which is where part of the hernia becomes trapped in the spigelian hernia and dies because it did not get enough blood, you will need surgery to correct this problem before the hernia can be repaired. Because a spigelian hernia is small the risk of bowel strangulation is high. In this surgery, the surgeon will remove the diseased, or dead, section of the bowel before any complications and infection can occur. Once this is done then the surgeon will repair the spigelian hernia.

Recovery time

After surgery, you can expect to have a lot of pain. Although the recovery time is about fourteen days you will also be restricted from any heavy physical activity for several weeks so it has a chance to heal.

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