A Spigelian hernia is the type of ventral hernia that occurs through the Spigelian aponeurosis, which is the part of the

aponeurosis An aponeurosis (; : aponeuroses) is a flattened tendon by which muscle attaches to bone or fascia. Aponeuroses exhibit an ordered arrangement of collagen fibres, thus attaining high tensile strength in a particular direction while being vulnerable ...

of the

transverse abdominal muscle The transverse abdominal muscle (TVA), also known as the transverse abdominis, transversalis muscle and transversus abdominis muscle, is a muscle layer of the anterior and lateral (front and side) abdominal wall, deep to (layered below) the inter ...

bounded by the

linea semilunaris The linea semilunaris (also semilunar line or Spigelian line) is a curved line found on either side of the rectus abdominis muscle. History The linea semilunaris was first described by Adriaan van den Spiegel. Structure There are two common ...

(or Spigelian line) laterally and the lateral edge of the

rectus abdominis The rectus abdominis muscle, () also known as the "abdominal muscle" or simply better known as the "abs", is a pair of segmented skeletal muscle on the ventral aspect of a person, person's abdomen. The paired muscle is separated at the midline b ...

muscle medially. It is the protuberance of omentum,

adipose tissue Adipose tissue (also known as body fat or simply fat) is a loose connective tissue composed mostly of adipocytes. It also contains the stromal vascular fraction (SVF) of cells including preadipocytes, fibroblasts, Blood vessel, vascular endothel ...

, or

bowel The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The tract is the largest of the body's systems, after the cardiovascular system. T ...

in that weak space between the abdominal wall muscles, that ultimately pushes the

intestines The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The tract is the largest of the body's systems, after the cardiovascular system. ...

or superficial fatty tissue through a hole causing a defect. As a result, it creates the movement of an organ or a loop of intestine in the weakened body space that it is not supposed to be in. It is at this separation (

) in the

ventral Standard anatomical terms of location are used to describe unambiguously the anatomy of humans and other animals. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position prov ...

abdominal region, that

herniation A hernia (: hernias or herniae, from Latin, meaning 'rupture') is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. The term is also used for the normal development of the in ...

most commonly occurs. Spigelian

hernia A hernia (: hernias or herniae, from Latin, meaning 'rupture') is the abnormal exit of tissue or an organ (anatomy), organ, such as the bowel, through the wall of the cavity in which it normally resides. The term is also used for the normal Devel ...

s are rare compared to other types of hernias because they do not develop under abdominal layers of fat but between fascia tissue that connects to

muscle Muscle is a soft tissue, one of the four basic types of animal tissue. There are three types of muscle tissue in vertebrates: skeletal muscle, cardiac muscle, and smooth muscle. Muscle tissue gives skeletal muscles the ability to muscle contra ...

. The Spigelian hernia is generally smaller in diameter, typically measuring 1–2 cm., and the risk of tissue becoming strangulated is high. Hernia spiegheli 01

Signs and symptoms

Individuals typically present with either intermittent pain, a lump or mass, all which are classic signs of a

bowel obstruction Bowel obstruction, also known as intestinal obstruction, is a mechanical or Ileus, functional obstruction of the Gastrointestinal tract#Lower gastrointestinal tract, intestines which prevents the normal movement of the products of digestion. Ei ...

. The patient may have a protuberance when standing in an upright position although discomfort can sometimes be confused by its anatomical region for a peptic ulceration. The bulge may be painful when the patient stretches but then goes away when they are lying down in a resting position. However, a number of patients present with no obvious symptoms but vague tenderness along the area in which the Spigelian fascia is located.

Diagnosis

Ultrasound Ultrasound is sound with frequency, frequencies greater than 20 Hertz, kilohertz. This frequency is the approximate upper audible hearing range, limit of human hearing in healthy young adults. The physical principles of acoustic waves apply ...

Imaging or a

CT scan A computed tomography scan (CT scan), formerly called computed axial tomography scan (CAT scan), is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers or ...

will provide better imaging for the detection of a hernia than an

X-ray An X-ray (also known in many languages as Röntgen radiation) is a form of high-energy electromagnetic radiation with a wavelength shorter than those of ultraviolet rays and longer than those of gamma rays. Roughly, X-rays have a wavelength ran ...

. The ultrasound probe should move from lateral to medially, a hypoechoic mass should appear

anteriorly Standard anatomical terms of location are used to describe unambiguously the anatomy of humans and other animals. The terms, typically derived from Latin or Greek language, Greek roots, describe something in its standard anatomical position. Thi ...

and medially to the inferior

epigastric In anatomy, the epigastrium (or epigastric region) is the upper central region of the abdomen. It is located between the costal margins and the subcostal plane. Pain may be referred to the epigastrium from damage to structures derived from the fo ...

artery An artery () is a blood vessel in humans and most other animals that takes oxygenated blood away from the heart in the systemic circulation to one or more parts of the body. Exceptions that carry deoxygenated blood are the pulmonary arteries in ...

during

Valsalva maneuver The Valsalva maneuver is performed by a forceful attempt of exhalation against a closed airway, usually done by closing one's mouth and pinching one's nose shut while expelling air, as if blowing up a balloon. Variations of the maneuver can be ...

. The diagnosis of a Spigelian hernia is traditionally difficult if only given a history and

physical examination In a physical examination, medical examination, clinical examination, or medical checkup, a medical practitioner examines a patient for any possible medical signs or symptoms of a Disease, medical condition. It generally consists of a series of ...

. People who are good candidates for elective Spigelian

surgery, after receiving an initial diagnostic consultation by a licensed medical professional, will be advised to see a physician to schedule surgery.

Treatment

The Spigelian hernia can be repaired by either an open procedure or

laparoscopic Laparoscopy () is an operation performed in the abdomen or human pelvis, pelvis using small Surgical incision, incisions (usually 0.5–1.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few ...

surgery because of the high risk of

strangulation Strangling or strangulation is compression of the neck that may lead to unconsciousness or death by causing an increasingly hypoxic state in the brain by restricting the flow of oxygen through the trachea. Fatal strangulation typically occurs ...

. Surgery is straightforward, with only larger defects requiring a mesh prosthesis. In contrast to the laparoscopic intraperitoneal onlay mesh plan of action there is a significant higher risk associated with complications and recurrence rates during the period following a surgical operation. A Spigelian hernia becomes immediately operative once the risk of incarceration is confirmed. Today, a Spigelian hernia can be repaired by doing robotic laparoscopy and most patients are

discharged Discharge may refer to: * The act of firing a gun * Termination of employment, the end of an employee's duration with an employer * Military discharge, the release of a member of the armed forces from service Flow * Discharge (hydrology), the a ...

on the same day. This novel, uncomplicated approach to small Spigelian hernias combines the benefits of laparoscopic localization, reduction, and closure without the

morbidity A disease is a particular abnormal condition that adversely affects the structure or function of all or part of an organism and is not immediately due to any external injury. Diseases are often known to be medical conditions that are asso ...

and cost associated with foreign material. Mesh-free laparoscopic suture repair is an uncomplicated approach to small Spigelian hernias combined with the benefits of a closure without the anguish and cost associated with foreign material.

Eponym

Adriaan van den Spiegel Adriaan van den Spiegel (or Spieghel), name sometimes written as Adrianus Spigelius (1578 – 7 April 1625), was a Flemish anatomist born in Brussels. For much of his career he practiced medicine in Padua, and is considered one of the great physi ...

was an

anatomist Anatomy () is the branch of morphology concerned with the study of the internal structure of organisms and their parts. Anatomy is a branch of natural science that deals with the structural organization of living things. It is an old scien ...

at the

University of Padua The University of Padua (, UNIPD) is an Italian public research university in Padua, Italy. It was founded in 1222 by a group of students and teachers from the University of Bologna, who previously settled in Vicenza; thus, it is the second-oldest ...

during the 17th century. He became a professor of surgery in 1619 and was the first to describe this rare

in 1627. The history of the Spigelian hernia was acknowledged in 1645, twenty years after Spiegel's death. In 1764, almost a century later, the Flemish anatomist, Josef Klinkosch, was acknowledged for recognizing and describing a hernia located in the Spigelian

fascia A fascia (; : fasciae or fascias; adjective fascial; ) is a generic term for macroscopic membranous bodily structures. Fasciae are classified as superficial, visceral or deep, and further designated according to their anatomical location. ...

, and coined the term Spigelian hernia.

Raveenthiran syndrome

Raveenthiran described a new syndrome in which Spigelian hernia and

cryptorchidism Cryptorchidism, also known as undescended testis, is the failure of one or both testes to descend into the scrotum. The word is . It is the most common birth defect of the male genital tract. About 3% of full-term and 30% of premature infant boy ...

(undescended

testis A testicle or testis ( testes) is the gonad in all male bilaterians, including humans, and is Homology (biology), homologous to the ovary in females. Its primary functions are the production of sperm and the secretion of Androgen, androgens, p ...

) occur together. Some common complications of this distinct syndrome

are

testicular torsion Testicular torsion occurs when the spermatic cord (from which the testicle is suspended) twists, cutting off the blood supply to the testicle. The most common symptom in children is sudden, severe testicular pain. The testicle may be higher tha ...

, and its link to

testicular cancer Testicular cancer is cancer that develops in the testicles, a part of the male reproductive system. Symptoms may include a lump in the testicle or swelling or pain in the scrotum. Treatment may result in infertility. Risk factors include an c ...

References

External links

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Laparoscopic Repair of Spigelian Hernia
Medtube'' {{Commons category, Spigelian hernia
Hernias