FULL TEXT - Hospital Aeronáutico Central

FULL TEXT - Hospital Aeronáutico Central

Hosp Aeronáut Cent 2012; 7(1): 33-35
Spigelian Hernia
Rodolfo Faraco (MAAT) (FACS)*, Cap. (E. Med.) María J. Brondolo (MAAC)*, Gustavo Wasielewsky
(MAAC)*, Eduardo Somma (MAAC)*, 1er Ten. “e.c.” (E. Med.) Juan Pablo Fernández**, 1er Ten. “e.c.” (E.
Med.) Verónica D’Amore**
General Surgery Department – Hospital Aeronáutico Central – Ventura de la Vega 3697 – Ciudad
Autónoma de Buenos Aires
*
Surgeon of the General Surgery Department, Hospital Aeronáutico Central
**
Resident of the General Surgery Department, Hospital Aeronáutico Central
th
th
Received: January 24 , 2012. Accepted: February 15 , 2012
Introduction
with a 4-year evolution, which protrudes in the
Spigelian hernias are a rare variety of hernial
defects of the abdominal wall, accounting for
nearly
1%
of
all
hernias1.
The
Spigelian
aponeurosis lies between the semilunar line and
the lateral border of the abdomen anterior rectus
muscle3. A Spigelian hernia belt is described
located between a line joining both anterior
superior iliac spines and a transversal band lying
6cm above. 85%-95% of Spigelian hernias are
found in this site. The low frequency of this type of
standing
position
and
Valsalva
manoeuvre
(photograph 1). She denied any disturbances in
her bowel habits or any other concomitant
symptoms. An abdomen CT scan was used
(photographs 2 and 3) and routine preoperative
tests were performed. The hernial sac was
removed by surgery and an extraperitoneal
absorbable mesh was applied, leaving drainage in
the subcutaneous cellular tissue (photographs 4,
5, 6, 7).
hernias below the level of the umbilicus is
attributed to the fact that in this region the
semilunar line is located behind the abdomen
anterior rectus muscle4.
Objectives
Case presentation and revision of literature.
Case Report
58-year-old female patient, consulting because of
a nearly 10x20cm right lateral abdominal tumor,
Hospital Aeronáutico Central
Photograph 1: Presurgery appearance of patient with
Spigelian Hernia.
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Spigelian Hernia
Photograph 2: Abdomen CT –hollow organs are observed
outside the abdominal cavity.
Photograph 6: Synthesis of the aponeurotic plane.
Photograph 3: Abdominal CT –solution of continuity of the
abdominal wall.
Photograph 7: Right paramedian incision. Drainage in the
subcutaneous cellular tissue was placed.
Photograph 4: Hernial sac protruding through the abdomen
muscles.
Discussion
The term “Spigelian hernia” makes reference to
the ones located above the inferior epigastric
vessels; those located below them, medial to the
inguinal canal, are called “low” hernias2. Most
hernias occur below the external oblique muscle,
among
the
different
muscle
layers
of
the
abdominal wall, and are thus commonly known as
hidden hernias, interstitial hernias or interparietal
Photograph 5: Mesh fixation at cardinal points.
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hernias . They are superficial in a low percentage,
Faraco et al, Rev Hosp Aeronaut Cent 2012; 7(1): 33-35.
when the hernial sac protrudes through the
external
oblique
muscle
aponeurosis,
2.
Mitidieri, V.; Mitidieri, A.; Coturel, A.Consideraciones
Anatomoquirúrgicas acerca de la línea de Spiegel.
being
Revista Argentina de Anatomía Online 2010 (Julio –
subcutaneous and easy to detect during clinical
Agosto –Septiembre), Vol. 1, Nº 2, pp. 33 –80.ISSN
exploration6. Pain is the most frequent symptom,
impresa 1853-256X / ISSN online 1852-9348.
followed by the appearance of a mass referred to
3.
Moles Morenilla, L.; Docobo Durántez, F.; Mena
by the patient, not always palpable. Changes in
Robles, J.; y Quinta Frutos, R. Hernia de Spiegel en
the bowel transit can occur depending on the
España. Análisis de 162 casos. Rev Esp. Enferm.
content of the hernial sac. Some cases are
6
Dig. 2005; 97(5): 338-347.
4.
asymptomatic . CT and ultrasound scans can be
Nyhus L & Condon R . Lippincott Company,
useful in the diagnosis, mainly as regards the
defect location, size, surrounding structures and
Philadelphia, 1995.
5.
choose the type of surgery- . High suspicion and a
through exploration are imperative in order to
arrive a correct diagnosis.
References
1.
Pul, N.; y Mehmet, P. Spigelian Hernia in children.
Yonsei Medical Jurnal. Vol. 35, Nº 1, 1994.
sac content -important information to adequately
1
th
Spangen, L. Spigelian Hernia. In: Hernia, 4 Edition,
6.
Ruiz de la Hermosa, A.; Amunategui Prats, I.;
Machado Liendo, P.; Nevarez Noboa, F. y Muñoz
Calero, A. Hernias de Spiegel. Nuestra experiencia y
revisión de la literatura. REV ESP ENFERM DIG
(Madrid). 2010, Vol. 102. N.° 10, pp. 583-586.
Cerdán, R.; Blázquez, C.; Barranco j.; Bernal Jaulín,
J y Duque Mallén, M.; Hernia de Spiegel. Revisión a
propósito de 8 casos. Rev Cubana Cir 2005; 44(4).
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