Presentation
Painful mass in the right lower quadrant. Had total hysterectomy with appendiecectomy (Maylard incision) 7 years ago for uterine fibroids.
Patient Data
There is a defect of the right abdominal wall lateral to the lateral border of the rectus abdominis muscle along the Spigelian line with an herniated sac containing a dense fatty structure covered by the aponeurosis of the external oblique muscle and prolonged into the abdominal cavity, ending on the cecum, suggestive of an epiploic appendagitis through a Spigelian hernia.
Case Discussion
Epiploic appendagitis within a Spigelian hernia is very rare, only few cases have been described in the literature. The clinical presentation depends on the location, mimicking acute appendicitis on the right side and sigmoid diverticulitis on the left side.
Additional contributor: C Boukaaba, MD.
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