Presentation
Sudden onset abdominal pain.
Patient Data
Non-contrast CT scan demonstrates right lateral anterior abdominal wall hernia (spigelian hernia) with obstructed small bowel loop component and dilated proximal small bowel loops, stomach and lower esophagus. Features are consistent with incarcerated spigelian hernia.
Case Discussion
There are typical features of incarcerated hernia demonstrated by a narrow neck and proximal small bowel obstruction. The site of hernia is specific for spigelian hernia, which is between the lateral border of rectus abdominis muscle and the semilunar line.
Spigelian hernia or lateral ventral hernia is very uncommon with an estimated incidence of 0.1% of abdominal wall hernias. Incarcerated spigelian hernia associated with small bowel obstruction is very rare.
Imaging is vital in abdominal emergencies. It is of utmost importance in clinically occult cases, especially in diagnosing complications like incarceration, strangulation, obstruction and necrosis, which might be a surgical emergency.
Additional case author: Dr Palak Thakrar (drpalakt@gmail.com)
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