Spigelian hernia: traumatic
Handle-bar injury to right lower abdominal wall with bruising and acutely painful, palpable lump after coughing.
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Typical location of a Spigelian hernia lateral to the rectus abdominis muscle. In this case it is traumatic due to a direct bicycle handle-bar impact injury at the site. This is very unusual. Note soft tissue swelling in the adjacent subcutaneous fat as well as the clinical skin bruising.