Complicated Spigelian hernia presenting with sigmoid colon strangulation: A unique clinical report

• Published in: International journal of surgery case reports Vol. 120; p. 109833
• Main Authors: Ba-shammakh, Saleh A., Alrayes, Bourhan, Almasarweh, Sami A., Alseragi, Muna A., Rabadi, Daher K.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-07-2024; Elsevier
• Subjects: Case Report; Computed tomography (CT); Sigmoid colon strangulation; Spigelian hernia; Surgical management; Spigelian hernia; Surgical management; Case report; Computed tomography (CT); Sigmoid colon strangulation
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2024.109833

Spigelian hernias are rare, constituting about 1–2 % of all abdominal wall hernias. They present clinically significant challenges due to their potential for incarceration and strangulation. This case report highlights a unique presentation of a Spigelian hernia involving sigmoid colon strangulation, emphasizing the critical need for awareness and timely intervention.
A 60-year-old female with hypertension and diabetes presented with severe left abdominal pain, nausea, and vomiting. Examination revealed leukocytosis, neutrophilia, and signs of acute abdomen. CT imaging showed a complicated left lateral abdominal wall hernia containing the sigmoid colon. Surgical intervention included sigmoidectomy with colorectal anastomosis and hernia repair. Postoperative recovery was successful with subsequent elective ileostomy reversal.
The rarity of Spigelian hernias and their atypical presentations can complicate diagnosis and management. This case was particularly challenging due to the strangulation of the sigmoid colon within the hernial sac. Surgical management was necessary to address the incarcerated bowel segment and prevent further complications. This case underscores the utility of CT scans in diagnosing complex cases and guiding surgical strategy.
Despite their rarity, Spigelian hernias carry significant risks of strangulation. Prompt diagnosis and treatment are essential to avoid severe complications. This case highlights the importance of including Spigelian hernia in the differential diagnosis for acute abdominal symptoms, especially when they are nonspecific.
•Describes a unique instance of Spigelian hernia involving sigmoid colon strangulation in a 60-year-old female, leading to severe symptoms.•Emphasizes the importance of CT in diagnosis and details the complex surgical intervention required for treatment.•Notes the successful recovery following surgery, highlighting the effective management of this complicated case.