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Spigelian hernia

A Spigelian hernia is a type of abdominal hernia.

Epidemiology

They are rare and are throught to 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.

Pathology

They may be congenital or acquired.

Location

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.

Radiographic appearance

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

Ultrasound can be recommended for verification of the diagnosis in both palpable and nonpalpable spigelian hernia.

CT

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.

Etymology

Although it is named after Adriaan van 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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