What Is Spigelian Hernia?
The Spigelian fascia is a layer of tissue that divides the two muscle groups in the abdomen's front. A Spigelian hernia occurs when a slit-like opening appears in this fascia. The intestines and the peritoneum, a layer of tissue that is present over the abdominal organs, are usually affected by this condition. A Spigelian hernia can also affect the caecum, appendix, and other organs. Spigelian hernias account for 0.12 % to 2 % of all abdominal wall hernias. They are significantly less common than the inguinal hernia or femoral hernia.
What Are the Causes of Spigelian Hernia?
Spigelian hernias, like other types of hernias, are caused by weaknesses in the abdominal wall muscles. This allows organs and tissue to protrude. A hernia can be caused by a variety of factors. Some people develop abdominal weakness as a result of an injury, such as lifting a heavy object. In other cases, the hernia is the result of a condition that causes chronic coughing, such as the common cold, bronchitis, or allergies. Ascites is a weakness in the abdominal walls caused by excess fluid in the abdomen. Spigelian hernias are uncommon, but they can occur at any age. However, there are people who are at a higher risk. The two main risk factors are pregnancy and being overweight.
What Are the Symptoms of Spigelian Hernia?
One may have a Spigelian hernia if they feel a soft, small lump or bulge on the abdominal wall. This lump or bulge, which is usually covered by fat, is often painless and more noticeable when you stand. The size, on the other hand, frequently increases and decreases on its own.
This type of hernia may also result in the following:
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Pain in the abdomen that is not caused by food or illness.
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Increased pain while coughing, for example, motioning to pass something or lifting something heavy.
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Constipation or a change in bowel habits.
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Blood in the stools.
What Are the Risk Factors of Spigelian Hernia?
Both types of surgery can be performed as outpatient procedures, or one may be required to stay in the hospital for one night. Recovery time for open mesh repair is three to six weeks, and one to two weeks for laparoscopic hernia repair. During the recovery, one should avoid strenuous activity. Surgical risks include bleeding or bruising beneath the skin, as well as infections. Consult a doctor in case one has increased pain, persistent bleeding, a fever, or vomiting following hernia repair surgery.
What Are the Complications of Spigelian Hernia?
These hernias, if left untreated, can be life-threatening complications and cause significant damage. Hernias can also grow in size. This can cause a bowel blockage or cut off blood supply to your major organs. Strangulation is the medical term for this complication. Strangulation symptoms include vomiting, nausea, and severe abdominal discomfort. Even if the Spigelian hernia does not enlarge or cause pain, the doctor may advise having it repaired.
Preoperatively complications are incarceration, strangulation, and bowel obstruction, and postoperatively complications are mesh infection, seroma, hematoma, mesh infection, hernia recurrence, surgical site infection, and injury to the bowel.
What Are the Diagnostic Tests for Spigelian Hernia?
Consult a doctor if a person suspects having a hernia. It is possible to live with a hernia if the person is not in pain or discomfort. However, any hernia that causes pain requires medical attention. A Spigelian hernia will not heal on its own. Upon completion of a physical examination, doctors can usually diagnose an ordinary hernia. Spigelian hernias are more difficult to diagnose as they do not have the same physical characteristics as other hernias. A bulge or lump is not always visible in a Spigelian hernia because it develops within the muscle wall. The doctor may enquire about the location of the pain before ordering an imaging test to examine the inside of the body.
What Is the Differential Diagnosis of Spigelian Hernia?
A Spigelian hernia has a relatively narrow differential diagnosis, but it also includes other morbid conditions. Other pathologies to consider are rectus sheath hematoma, ventral hernia, incisional hernia, soft tissue or abdominal wall cancer, abscess, or lymphadenopathy.
What Are the Treatment Options Available for Spigelian Hernia?
A Spigelian hernia can only be treated with hernia repair surgery. The size of the hernia and whether or not the person is in pain influence the decision to have surgery. If one chooses surgery, an open mesh repair can be performed by making an incision in the abdomen near the hernia. The surgeon repositions bulging tissue and organs before repairing the hole in the stomach wall. One can also correct the hernia with a minimally invasive procedure known as laparoscopic hernia repair. A surgeon uses a thin surgical instrument with a camera attached to the end to repair the hernia through a smaller incision in the abdomen.
The traditional open surgical technique is described, and repair can be accomplished using either primary fascial closure or mesh. This procedure is typically performed through a transverse or even a left paramedian incision. Gridiron's or McBurney's incisions are traditionally made at a right angle to a line connecting the umbilicus and anterior superior iliac spine centered on McBurney's point. The hernia sac is identified and isolated as the dissection proceeds posteriorly. The hernia may be easily reduced with omentectomy or herniotomy, or bowel resection, depending on the contents of the sac and the presence or absence of bowel strangulation. When closing the fascial defect, some surgeons may use non-absorbable sutures, while others may use synthetic mesh.
Conclusion:
A Spigelian hernia can be painful, uncomfortable, and eventually enlarged. Spigelian hernias are uncommon, but they can be difficult to diagnose and may need surgery to close the abdominal muscle hole. However, the prognosis for patients with Spigelian hernias is typically good with early diagnosis and prompt medical attention. Patients can resume their regular activities with little discomfort after surgery to repair the hernia, which can also relieve symptoms and avoid complications.
