Presentation
Right palpable bulge along the semilunar line at the Spigelian fascia with abdominal pain, nausea, and vomiting in patient with pancreatic neoplasm, liver metastasis and splenic ischemic areas.
Patient Data
Small bowel obstruction with multiple jejunal air-fluid levels.
Pancreatic tail neoplasm with liver metastases and ascites. Omental fat and loop of small bowel has herniated through the lateral edge of the right rectus muscle at the semilunar line and produced a mechanical small bowel obstruction with multiple jejunal air-fluid levels, without bowel ischemia signs.
Management
The hernia was manually reduced in the abdomen.
Case Discussion
Spigelian hernia is the protrusion of a peritoneal sac, organs, or of preperitoneal fat, through a congenital or acquired defect in Spiegel's aponeurosis. A Spigelian hernia typically results from underlying pathology which increases intra-abdominal pressure, abdominal wall trauma, or degeneration of the aponeurotic layers of the abdominal wall as happens with aging or disorders of collagen synthesis. In other cases, this hernia can be idiopathic (spontaneous lateral ventral hernia).