Spigelian Hernia

What is Spigelian Hernia?

A hernia is a condition whereby an organ pushes out of the tissue or muscle holding it in place through a weakness on the wall. Spigelian hernia (also called lateral ventral hernia) is a type of hernia that occurs in the spigelian fascia, which is a tissue that separates two abdominal muscles; the rectus abdominis (rectus muscles) and the semilunar muscle (lateral obliques). It is a rare type of hernia constituting 0.12% of all reported abdominal hernias, and 1-2% of all reported hernias. This is because the abdominal muscles are usually have enough strength and able to hold abdominal organs in place.

Location of Spigelian hernia

Spigelian hernia is different from all other hernias. While other hernias develop below the subcutaneous fat layers, it is found between muscles of the abdomen. It usually shows no outward physical signs, like swelling. For this reason, it is not very easily identified. It is usually diagnosed after a long period of time when other abdominal problems arise. It should be treated immediately after diagnosis. If left untreated, it can result in serious constipation, bowel obstruction and may cut off blood supply to some organs. This makes it a life-threatening condition.

Where is a Spigelian Hernia located?

Spigelian hernia develops between the middle and lower abdomen (on the lateral edge), through a layer of tissue called spigelian fascia which separates the two parts of the abdomen. The middle abdomen is medically referred to as rectus abdominis while the lower part is called semilunar line.

Diagrammatic representation of different types of hernia’s and their location

What does a Spigelian Hernia feel like?

As spigelian hernias occur between muscles, they do not usually form the bulge that can be seen and felt through the skin as other hernias. This makes it hard to realize its presence until later when it starts producing symptoms.

Sometimes, however, one is able to see and feel the bulge, especially when it is a large one. This is a high-risk stage that is accompanied by a lot of pain. The bulge is usually soft and unexplained, on the abdomen.

Symptoms

The most common symptoms of spigelian hernia are:

• Continuous or recurring burning pain in the abdomen
• Increased pain when lifting heavy things, coughing or having a bowel movement
• Obstruction of the bowels
• Back pain
• Grayish or greenish appearance of the skin on the abdomen due to lack of blood flow to the organs
• Constipation
• Blood in the stool
• Pain after eating
• Nausea and vomiting
• Small soft unexplained swelling on the abdomen
• Flank pain, especially around the pelvis

Causes

The immediate cause of all hernias is a weakness or hole in the wall or tissue that holds the organ in place. Spigelian hernia is no different. It is caused by a weakness in the abdominal wall which leads to a protrusion of the abdominal organs into the abdominal muscles. The weakness in the wall is caused by various factors as explained below:

• Chronic coughing, vomiting, and sneezing – These cause continuous and repetitive contractions of most body muscles. This strain on the abdominal walls can weaken them, leading to spigelian hernia.
• Obesity – Too much fat in the body may be lodged on abdominal walls. Despite their strength, they may be unable to bear the weight, and eventually weaken or even collapse in the cases of extreme obesity.
• Strain full physical activities and exercise – lifting of very heavy objects may build up pressure in the abdominal area, leading to weakness of the abdominal wall
• Constipation – during bowel movements, constipated people may need to exert more pressure to pass bowels. This pressure damages the abdominal wall, especially when constipation is frequent.
• Post-surgery infection – After an operation on the abdomen, the abdominal wall sometimes get infected and consequently weakened.
• Heavy labor – women who give birth naturally usually exert a lot of force in the ‘pushing’ process. This pressure on the abdomen could result in a hernia.
• Genetic problems – Some people may inherit hernia, especially in families with a known recurrence.
• Congenital defect– Spigelian hernia may be a result of improper development of the abdominal wall before birth
• Injuries to the abdomen – Sometimes, when people get physically injured on the abdomen, the abdominal wall receives some trauma that gradually weaken it.
• Ascites – This is a condition whereby the liver stops functioning normally or properly, and there is a fluid build-up in the abdomen. These fluids build up pressure against the abdominal wall and eventually lead to the hernia.
• Multiple pregnancies– Multiparous women have been found to have a focal tenderness and or a mass along the linea semilunaris, which results to the spigelian hernia, strangulation of the intestines and bowel constriction.

Treatment

Once spigelian hernia is suspected by a doctor, the following tests may be performed to diagnose it:

• CT scan
• Ultrasound
• MRI
• Ultrasonography

These tests help show any abnormalities in the spigelian line, which can help detect presence of the hernia. They also show its position and size.

One can live with a hernia if it is not painful and does not pose a risk to the health or other body organs, and life generally. However, in the case of spigelian hernia, surgery is performed to repair the weakness or hole on the abdominal wall or remove it and strengthen the damaged part with surgical mesh.

There are two types of surgeries for spigelian hernia: laparoscopic surgery and open surgery.

Laparoscopic surgery involves making a small incision and using a small tube and camera to view and guide the doctor to the affected part. The doctor then repairs the damaged part using surgical mesh.

Open surgery involves making a larger incision on the abdomen. The doctor is able to directly view and treat the hernia as deemed necessary.

Laparoscopic surgery is preferable as it has fewer complications and takes a shorter time to heal.

Various surgical approaches used include endoscopic, total extra peritoneal repair, conventional, and trans abdominal preperitoneal repair.

Is a Spigelian Hernia dangerous?

Yes, spigelian hernia is very dangerous, especially when left untreated. It can lead to complication such as inability to pass bowels, strangulation of the intestines and lack of blood flow. In the long run, it will most probably lead to death. It is therefore advised to seek treatment as fast as possible.

Can a Spigelian Hernia heal itself?

While other mild hernias especially those that do not cause any pain can eventually heal by themselves, spigelian hernia does not. In fact, it will get worse and become more dangerous to the other organs. Therefore immediate treatment is required.

Conclusion

Spigelian hernia is a life-threatening hernia that can occur in all people. It usually occurs in people between 50-70 years, most commonly in women. It should be treated immediately when diagnosed as further delay could pose a danger to other organs in the abdomen, and the body at large.

The best way to avoid this condition is to take proper care of the body to avoid self-imposed hernias. You should exercise regularly and eat well to avoid obesity. At the same time, you should avoid straining the body unnecessarily, for instance, by doing strenuous exercise and lifting objects that are too heavy. In case of any extreme injuries on the abdomen, you should visit a doctor to have your abdomen examined for any damage on the abdominal wall, tissues, and organs.