Spigelian hernia - traumatic
Handle-bar injury to the right lower abdominal wall with bruising and acutely painful, palpable lump after coughing.
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Herniation of bowel loops through abdominal wall defect at the lateral border of the right rectus abdominis muscle (linea semilunaris) consistent with Spigelian hernia. No related bowel obstruction.
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.