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Spigelian hernia causing small bowel obstruction

Case contributed by John Li
Diagnosis certain

Presentation

Right lower abdominal lump associated with pain, nausea and vomiting. Nil previous surgical history

Patient Data

Age: 80 years
Gender: Male

Multiple dilated loops of small bowel throughout the abdomen including fecalised ileal loops in the right lower quadrant.  A transition point is identified within a right-sided Spigelian hernia which contains free fluid and a loop of distal ileum.  The hernia measures 54 x 21 mm in axial plane with a 25 mm neck. No evidence of pneumoperitoneum.

Case Discussion

This patient's hernia was reduced in the emergency department. They proceeded to a diagnostic laparoscopy to inspect the small bowel, which was viable, and a Spigelian hernia repair.

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