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The Spigelian hernia: radiographic manifestations

1970; Wiley; Volume: 43; Issue: 516 Linguagem: Inglês

10.1259/0007-1285-43-516-903

1748-880X

Edward J. Arida, Shin Keun Joh, Gabriel F. Cucolo,

Urological Disorders and Treatments

The Spigelian hernia is a form of spontaneous lateral ventral hernia which occurs in the linea semilunaris (Spigelius' line) due to developmental or acquired weakness of fibres of the internal oblique and transversus abdominis muscles. Spigelian hernias most frequently occur at the junction of the linea semilunaris and the linea semicircularis of Douglas and therefore most commonly present as small intramural masses situated at the lateral margin of the rectus sheath approximately halfway between the umbilicus and the pubic symphysis. They most often contain omentum, rarely intestine and are frequently asymptomatic. Their presentation as a primary cause of intestinal obstruction is rare. In view of these anatomical and clinical characteristics, the pre-operative radiographic recognition of an obscure lower abdominal, paramedian mass as a Spigelian hernia may be of considerable clinical significance, particularly in the absence of an obvious defect or surgical scar in relationship to the mass. The case described below illustrates this concept and further illustrates the radiographic recognition of a ventral hernia as a primary cause of mechanical small bowel obstruction in the absence of a post-operative surgical scar. A careful review of the medical literature has failed to reveal a single such report. A 71-year-old male was admitted to the Lutheran Medical Center in September, 1969 complaining of generalised, colicky and eventually constant abdominal pain. The pain had come on suddenly and was not accompanied by nausea or vomiting. The patient was constipated. Past history was not helpful, with no previous abdominal surgery.