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Pediatric Spigelian hernia: A case report
Pediatric
Spigelian By Peter
*Report
of a Spigelian
yr old girl. common
than
diagnosis children
may
generally
should with
be
with strangulated
hernias
in childhood.
and 13
believed,
and
the
considered
in
all
pain,
Spigelian
hernia
hernias,
added
even
INDEX
recorded
H. Seltzer
in the
absence
of
a
palpable
mass.
abdominal
Scopinaro’
Porter4
Murray
be more
295 cases of Spigelian
patients have been adults. period
in a
well
intermittent
Approximately
A. Jarvis
hernia
The condition
Hernia: A Case Report
WORDS:
Spigelian
have been reported.’ three siblings,
and
Hurwitt3
three cases in young
With
all of whom
reported adults
hernia.
rare exception,
these
died in the neonatal
a case of bilateral to the literature
in
Spigelian 1969.
the
patients being 17, 19 and 23 yr old.
CASE A 13 yr old girl,
presented
abdominal
pain, associated
However.
on each occasion,
past medical was within
history normal
with
of repeated
episodes
on several occasions with a visible bulge lateral while being brought
revealed
to a physician,
no serious trauma
limits except
left rectus muscle, midway
REPORT
a 4 wk history
for the presence
between the umbilicus
or previous of a tender and pubis.
of left lower
the mass would operations.
disappear.
Physical
area at the lateral There
quadrant
to the rectus muscle. Her
examination border
of the
was no mass palpable
even
on straining. A preoperative plored through
diagnosis of Spigelian a transverse
left lower
hernia quadrant
was made
and the patient
was subsequently
incision.
passing through
the linea semilunaris
ex-
Ciesed lfernio Sac Tramversus Abd. /or. Obiique
Fig. 1. The layered hernia repair is depicted (the operative incision having been placed through the previously defined tender area at the lateral aspect of the left rectus muscle).
From the Deparrmenr of Surgery, Sainr Barnabas Medical Center, Livingston. New Jersey,. Address reprinr requesrs to: Murra! H. Selrzer. M.D., Dep. Surger!. Saint Barnabas Medical Cenrer. Livingston. N.J. 07039. cl1977 by Grune & Srrarron. Inc. Journal of Pediatric Surgery, Vol. 12, No. 4 (August). 1977
609
610
CASE
REPORTS
at the previously defined point of tenderness. A 2 3 cm defect in the transversalis fascia was located at the junction of the semilunar and semicircular lines. After opening the peritoneum to carry out intra-abdominal palpation and thereby rule out other anterior abdominal wall defects, a layered closure was performed to obliterate the hernia defect (Fig. I ).
DISCUSSION The hernia
ring through
which
a Spigelian
hernia
occurs
is located
in or near the vertical
linea
semilunaris at its junction with the semicircular fold of Douglas. At this point there exists a potential defect through which herniation can occur. The peritoneal sac extends through a usually well-defined ring defect in the transversalis fascia, transversus abdominus. and internal oblique and usually becomes interstitial, aponeurosis, lying beneath the stronger external oblique aponeurosis. Occasionally the latter is penetrated and the hernia comes to lie subcutaneously. Incarceration is common, and strangulation is seen almost as commonly as with femoral hernias since the ring in both is small and has sharp edges.4 Porters has pointed out that right-sided Spigelian hernias may be the cause of acute abdominal pain in many patients from whom normal appendices are removed. In the closure of the McBurney incision the surgeon inadvertently repairs the hernia, and the patient is asymptomatic thereafter. On rare occasions trauma6yay play a role in the genesis of Spigelian hernias. The literature records
’
two such instances.
REFERENCES I. Weiss Y. Lerman 0. Nissam hernia. Ann Surg 180:836. 1974 2. Scopinaro lunar 1935
AJ:
Hernia
line in a newborn.
in
Semana
S: Spigelian Spigel’s
semi-
Med
1:284.
3. Hurwitt ES, Borow MB: Bilateral Spigelian hernias in childhood. Surg 37:963, 1955 4. Leis HP Jr. Mersheimer
WL, Wintield
JM:
Spontaneous lateral ventral hernia. Surg 43:328, 1958 5. Porter S: Spigelian hernia, a cause of abdominal pain in young adults. J Iowa Med Sot 59: I 15, 1969 6. Hurlbut HJ, Moseley T: Spigelian hernia in a child. South Med J 60:602, 1967 7. Landry RM: Traumatic hernia. Amer J Surg91:301, 1956
Spigelian By Peter
*Report
of a Spigelian
yr old girl. common
than
diagnosis children
may
generally
should with
be
with strangulated
hernias
in childhood.
and 13
believed,
and
the
considered
in
all
pain,
Spigelian
hernia
hernias,
added
even
INDEX
recorded
H. Seltzer
in the
absence
of
a
palpable
mass.
abdominal
Scopinaro’
Porter4
Murray
be more
295 cases of Spigelian
patients have been adults. period
in a
well
intermittent
Approximately
A. Jarvis
hernia
The condition
Hernia: A Case Report
WORDS:
Spigelian
have been reported.’ three siblings,
and
Hurwitt3
three cases in young
With
all of whom
reported adults
hernia.
rare exception,
these
died in the neonatal
a case of bilateral to the literature
in
Spigelian 1969.
the
patients being 17, 19 and 23 yr old.
CASE A 13 yr old girl,
presented
abdominal
pain, associated
However.
on each occasion,
past medical was within
history normal
with
of repeated
episodes
on several occasions with a visible bulge lateral while being brought
revealed
to a physician,
no serious trauma
limits except
left rectus muscle, midway
REPORT
a 4 wk history
for the presence
between the umbilicus
or previous of a tender and pubis.
of left lower
the mass would operations.
disappear.
Physical
area at the lateral There
quadrant
to the rectus muscle. Her
examination border
of the
was no mass palpable
even
on straining. A preoperative plored through
diagnosis of Spigelian a transverse
left lower
hernia quadrant
was made
and the patient
was subsequently
incision.
passing through
the linea semilunaris
ex-
Ciesed lfernio Sac Tramversus Abd. /or. Obiique
Fig. 1. The layered hernia repair is depicted (the operative incision having been placed through the previously defined tender area at the lateral aspect of the left rectus muscle).
From the Deparrmenr of Surgery, Sainr Barnabas Medical Center, Livingston. New Jersey,. Address reprinr requesrs to: Murra! H. Selrzer. M.D., Dep. Surger!. Saint Barnabas Medical Cenrer. Livingston. N.J. 07039. cl1977 by Grune & Srrarron. Inc. Journal of Pediatric Surgery, Vol. 12, No. 4 (August). 1977
609
610
CASE
REPORTS
at the previously defined point of tenderness. A 2 3 cm defect in the transversalis fascia was located at the junction of the semilunar and semicircular lines. After opening the peritoneum to carry out intra-abdominal palpation and thereby rule out other anterior abdominal wall defects, a layered closure was performed to obliterate the hernia defect (Fig. I ).
DISCUSSION The hernia
ring through
which
a Spigelian
hernia
occurs
is located
in or near the vertical
linea
semilunaris at its junction with the semicircular fold of Douglas. At this point there exists a potential defect through which herniation can occur. The peritoneal sac extends through a usually well-defined ring defect in the transversalis fascia, transversus abdominus. and internal oblique and usually becomes interstitial, aponeurosis, lying beneath the stronger external oblique aponeurosis. Occasionally the latter is penetrated and the hernia comes to lie subcutaneously. Incarceration is common, and strangulation is seen almost as commonly as with femoral hernias since the ring in both is small and has sharp edges.4 Porters has pointed out that right-sided Spigelian hernias may be the cause of acute abdominal pain in many patients from whom normal appendices are removed. In the closure of the McBurney incision the surgeon inadvertently repairs the hernia, and the patient is asymptomatic thereafter. On rare occasions trauma6yay play a role in the genesis of Spigelian hernias. The literature records
’
two such instances.
REFERENCES I. Weiss Y. Lerman 0. Nissam hernia. Ann Surg 180:836. 1974 2. Scopinaro lunar 1935
AJ:
Hernia
line in a newborn.
in
Semana
S: Spigelian Spigel’s
semi-
Med
1:284.
3. Hurwitt ES, Borow MB: Bilateral Spigelian hernias in childhood. Surg 37:963, 1955 4. Leis HP Jr. Mersheimer
WL, Wintield
JM:
Spontaneous lateral ventral hernia. Surg 43:328, 1958 5. Porter S: Spigelian hernia, a cause of abdominal pain in young adults. J Iowa Med Sot 59: I 15, 1969 6. Hurlbut HJ, Moseley T: Spigelian hernia in a child. South Med J 60:602, 1967 7. Landry RM: Traumatic hernia. Amer J Surg91:301, 1956