Spigelian Hernia

What is Hernia?

Sometimes our bodies especially muscles do have weak spots. These weak spots can be caused by increased pressures when the body is still unable to handle the weight such as lifting very heavy objects.

They can also be caused by persistent coughing and sneezing, smoking and child birth which weaken the muscles.

When the muscles are weak, it provides opportunities for other body organs or fatty tissues to pass through. The result is what is called hernia. Hernia mostly occurs in the lower abdomen. They are not necessarily fatal but they cannot disappear by themselves. Surgery has to be done. ^{[1, 2]}

Picture 1 : Hernia at the lower part of the abdomen.
Image Source: www.sciencephoto.com

What is Spigelian Hernia?

This type of hernia was named after a Belgian anatomist Adriaan van den Spieghel who described the semilunar line. Spigelian Hernia was later described by Klinkosch in 1764. It is found in the abdomen muscles along the semilunar line. It is very small and therefore not easy to detect. ^{[3, 4]}

Anatomy of Spigelian Hernia

Spigelian hernia is through spigelian fascia which is between the abdominal muscles but along the semilunar line. Semilunar takes the shape of a curve on either side of the abdomen.

Diagram : Location and Anatomy of Spigelian Hernia

 Figure 2 : Shows the position of Spigelian Hernia
Image Source: ehealthwall.com

Semilunar line is the curved line on either side of the abdomen. The Spigelian Hernia belt shows the possible areas in which the hernia can be formed. Number 3 is the arcuate line just above the Monro line.

Hernia is formed when it penetrates between Spigelian Fascia and internal abdominal muscles. The hernia pouch positions itself between two abdominal muscles. The position and size (< 2cm in diameter) makes it unnoticeable because it does not protrude below the subcutaneous fat and therefore very easy to cause suffocation.

Signs and Symptoms

• If the patient has a deep lump along the semilunar line.
• It is also detectable if the lump is noticeable when the patient sits upright and disappears when lying down. Other times it is not noticeable, only the abdominal pain is felt.
• Indigestion due to bowel obstruction. Bowel obstruction is caused by hindrance in the intestines making digestion difficult.
• Recurring pain in the lower abdomen. Intensity of pain varies depending on the size of the hernia.
• Nausea and vomiting ^{[5, 6]}

Causes of Spigelian Hernia

The following are possible causes of Spigelian Hernia.

• Trauma or injury
• Post-surgery infection
• Pregnancy (heavy labour) or child birth
• Retention of urine for longer hours without release
• Heredity
• Severe vomiting and sneezing
• Obesity ^{[3, 5]}

Spigelian Hernia Diagnosis

• A Computed Tonography can be used for diagnosis. This equipment is able to show numerous angles with diverse dimensions.
• Ultra sound is also an efficient way for diagnosis since it uses high frequency waves to produce images.
• Magnetic Resource Imaging is effective in giving clear contrast between body tissues making it easier for a defect to be noticed easily. ^{[6, 8]}
• The patient is first assessed to determine whether they are ready to undertake surgery. Several tests are performed such as cardiogram, blood tests and x-ray.
• The doctor then sets the date of operation unless medical reasons that would require the patient to be admitted prior to surgery.^[10]

Spigelian Hernia Treatment

Treatment for Spigelian Hernia is not definite because of the possibility of strangulation. This has therefore made surgery to be the most effective method of treatment since this defect has minimal chances of recurring. ^{[6, 8]}

Repair

• Anesthetics will be used to numb the patient.
• Incision is done just close to the hernia to provide enough space for its extraction. ^[10]
• A surgical procedure is undertaken such that hernia is removed or repaired in order to strengthen the tissues to avoid the possibility of another hernia. Strengthening of the tissues is done by using a surgical mesh. A surgical mesh is an interwoven cloth that is mostly used to treat wounds and strengthen tissues especially after an accident. This type of surgery is known as the laparoscopic surgery. Chances of infection with kind of surgery are minimal. ^{[3, 9]}

Picture 3: Shows the repair of tissues done by using a surgical mesh.

Image Sources:i.ytimg.com

Recovery Time

• After the surgery is undertaken, the patient is introduced to fluids and light diets. The patient should be cautious not to take foods that cause constipation.
• Abdominal pains are predictable after operation.
• The wound will be treated and wrapped for approximately 5 days which after that the patient can resume bathing.
• The patient is advised not perform tedious jobs for at least two weeks.^[10]
• The patient does not take a long time to recover. Recovery span is estimated to be around two weeks. The doctor then conducts a post-surgery follow up on the patient to rule out any other future complications. ^{[3, 9]}

Conclusion

Spigelian hernia is not a grave disease if diagnosed early and treated because it does not take a long time for the patient to fully recover. Even though, no specific treatment procedure has been determined, surgery has proved to be beneficial to curb it.

References

1. National Library of Medicine.
2. http:// www.web.md.com
3. Radiographics. 1995;15 (2): 315-32. Radiographics (citation) – Pubmed citation
4. Minim Access Surg. 2008;4 (4): 95-98. J Minim Access Surg (link) – Free text at pubmed – Pubmed citation
5. Report of case and technique. Am J Obstet Gynecol. 1992;167:77–8. [PubMed]
6. Laparoendoscopy Adv Surg Tech. 2000;10:79–84. [PubMed]
7. http://www.youtube.com
8. J Laparoscopy Adv Surg Tech. 1997;7:385. [PubMed]
9. http://healthool.com/spigelian-hernia/
10. https://www.yumpu.com/en/document/view/49259352/epigastric-hernia-repair