Spigelian hernia, also known as hernia spiegeli, hernia spigeli or lateral ventral hernia, is a type of abdominal hernia along the semilunar line, resulting in herniation between the muscles of the abdominal wall.
They are rare and account for ~1% (range 0.1-2%) of ventral hernias 2-3. The incidence is thought to peak at around the 4th to 7th decades. There may be a slightly increased female predilection with a male to female ratio is 1:1.18 3.
They may be congenital or acquired.
A spigelian hernia is associated with the ipsilateral cryptorchidism among 75% male infants 5.
Two hypotheses has been proposed to explain the association, but the exact hypothesis is always a debate
- Spigelian-cryptorchidism syndrome (failure in the development of a gubernaculum) 5,
- Raveenthiran syndrome (ectopic testis from a potential hernia sac) 6.
The hernial orifice of a Spigelian hernia is usually located along the semilunar line (Spigelian line) through the transversus abdominis aponeurosis (Spigelian fascia), close to the level of the arcuate line. The majority of Spigelian hernias are found in a transverse band lying 0-6 cm cranial to a line running between both anterior superior iliac spines referred to as the Spigelian hernia belt.
The diagnosis of a Spigelian hernia at times presents greater challenge than its treatment. The clinical presentation varies, depending on the contents of the hernial sac and the degree and type of herniation. The pain, which is the most common symptom, varies and there is no typical pain of a Spigelian hernia. Findings to facilitate diagnosis are palpable hernia and a palpable hernial orifice.
Ultrasound can be recommended for verification of the diagnosis in both palpable and nonpalpable Spigelian hernia.
The hernial orifice and sac can be well demonstrated by computed tomography, which gives more detailed information on the contents of the sac than does ultrasonic scanning.
Treatment and prognosis
The treatment is often surgical and the risk of recurrence is small.
History and etymology
Although it is named after Adriaan van den Spieghel (Belgian anatomist), who described the semilunar line, the hernia was thought to be first described by Klinkosch in 1764 3.
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- 2. Harrison LA, Keesling CA, Martin NL et-al. Abdominal wall hernias: review of herniography and correlation with cross-sectional imaging. Radiographics. 1995;15 (2): 315-32. Radiographics (citation) - Pubmed citation
- 3. Mittal T, Kumar V, Khullar R et-al. Diagnosis and management of Spigelian hernia: A review of literature and our experience. J Minim Access Surg. 2008;4 (4): 95-98. J Minim Access Surg (link) - Free text at pubmed - Pubmed citation
- 4. Aguirre DA, Casola G, Sirlin C. Abdominal wall hernias: MDCT findings. AJR Am J Roentgenol. 2004;183 (3): 681-90. AJR Am J Roentgenol (citation) - Pubmed citation
- 5. Rushfeldt C, Oltmanns G, Vonen B. Spigelian-cryptorchidism syndrome: a case report and discussion of the basic elements in a possibly new congenital syndrome. Pediatr. Surg. Int. 2010;26 (9): 939-42. doi:10.1007/s00383-010-2681-7 - Free text at pubmed - Pubmed citation
- 6. Raveenthiran V. Congenital Spigelian hernia with cryptorchidism: probably a new syndrome. Hernia. 2005;9 (4): 378-80. doi:10.1007/s10029-005-0316-z - Pubmed citation