Presentation
Large palpable lump in the right lower quadrant associated with pain.
Patient Data
There is an anatomical defect measuring ~25 mm in the anterior abdominal wall lateral to the lateral border of the right rectus abdominis muscle ~10 cm caudal to the umbilicus through which bowel loop and mesentery are protruded.
The right testis is absent in the right scrotal sac.
Spigelian hernia with the anatomical defect in the anterior abdominal wall lateral to the lateral border of rectus abdominis. The right testis is located at the level of the deep inguinal ring with normal vascularity.
Case Discussion
The patient had a right Spigelian hernia with ipsilateral cryptorchidism. He underwent hernia repair and right orchiectomy.
Spigelian hernia is a sequale of maldescended testis (ectopic testis) and raised intraabdominal pressure purposed by Raveenthiran in 2005. This hitherto unrecognized sequence of events in a patient with Spigelian hernia and cryptorchidism is named “Raveenthiran syndrome” 1.
A different theory was proposed by Rushfeldt et al. (2010) to explain the cause of Spigelian hernia, where failure of development of the gubernaculum followed by lack of inguinal canal and arrested testis results in hernia from the defect in the Spigelian fascia (Spigelian-cryptorchidism syndrome) 2.
The Spigelian fascia is the aponeurotic tendon between the oblique muscle laterally and the rectus muscle medially 3.
Spigelian hernias course anywhere along the Spigelian fascia and occur due to a torn transverse abdominis and internal oblique aponeurosis. The external oblique tendon is intact 3.
The hernia is commonly located inferior to the arcuate line at the place where the posterior rectus sheath is absent and is weakened by the penetration of the sheath by the inferior epigastric vessels.