Spigelian hernia (rare)

Spigelian hernia

 

They occur through spigel’s line or spigel’s fascia (shaded light blue below) which runs along the outside edge of each of the rectus abdominis (6 pack) muscles.

The name Although named after Adriaan van der Spieghel, he only described the semilunar line (linea Spigeli) (see 4 below shaded in light blue) in 1645.  [Diagram from British Journal of Surgery – May 2004 91:640–644, author Vos et al]

It was Josef Klinkosch (name long forgotten!) in 1764 who first defined the spigelian hernia as a defect, hole or hernia in the semilunar line.

 

Figure 1. Anatomy of abdominal wall.
1: Linea semilunaris (spigelian); 2: rectus abdominis muscle;
3: transversus abdominal muscle; 4: spigelian aponeurosis; 5: linea semicircularis

 

The information. Reading the article about them on Wikipedia is almost impossible to understand unless you are a doctor. I disagree with most of it – what it describes is simply not my experience.

In practice. I probably see about 3 or 4 a year – not many. They have normally been present for a while getting more troublesome to the patient, but are often not obvious when they see their doctor. That is certainly my experience and Indeed in Vos’ article (BJS 2004) they also note that the delay in diagnosis was usually ‘…doctor related as physicians are often not familiar with this defect’

Where I do worry is that the authors of this article then go on to say “Chronic obstructive pulmonary disease obesity are predisposing factors commonly observed in patients with other hernias”. – this is simply not true. So I start to question the overall understanding and experience of the authors. Remember they were only reviewing charts or notes – over 25 years – one patient a year!

So there is ALOT of DISINFORMATION about them on the internet – very misleading.

 

Symptoms and Diagnosis

 

Spigelian hernias tend to have a narrow neck Spigelian hernias are usually small and often start with pain or discomfort in the area – lower abdominal wall on the right or the left. Below the level of the umbilicus or navel. The bulge of the hernia is not often seen or felt (by doctors) as it lies beneath the aponeurosis (tendon like covering sheath) of the external oblique muscle. Confirmation of the diagnosis may require ultrasound or CT-scan.

MORE INFO to follow covering:

• How you know you have one
• How to confirm the diagnosis
• Who to go to
• What operation
• The success rate
• The downside