Ipsilateral Spigelian hernia with cryptrochidism

Case contributed by Dr Subash Thapa

Presentation

Large palpable lump in the right lower quadrant associated with pain.

Patient Data

Age: 30 years
Gender: Male

There is an anatomical defect measuring approx. 25 mm in the anterior abdominal wall lateral to the lateral border of right rectus abdominis muscle approx. 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 deep inguinal ring with normal vascularity.

Case Discussion

Patient had right Spigelian hernia with ipsilateral cryptorchidism. He underwent hernia repair and right orchiectomy.

Spigelian hernia in is a sequale of maldescended testis (ectopic testis) and raised intraabdominal pressure purposed by ‘Raveenthiran’ (2005). This hitherto unrecognized sequence of event in a patient with Spigelian hernia and cryptorchidism named as “Raveenthiran syndrome” 1.

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 result in hernia from the defect in the Spigelian fascia (Spigelian-cryptorchidism syndrome) 2.

Spigelian fascia is the aponeurotic tendon between oblique muscle laterally and the rectus muscle medially 3.

Spigelian hernias course anywhere along the Spigelian fascia and occurs due to torn transverse abdominis and the internal oblique aponeurosis. The external oblique tendon is intact 3.

Hernia is commonly located inferior to the arcuate line at the place where posterior recuts sheath is absent and is weakened by the penetration of sheath by the inferior epigastric vessels.

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Case information

rID: 40306
Case created: 17th Oct 2015
Last edited: 29th Feb 2016
Inclusion in quiz mode: Included

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