Spigelian hernia
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Spigelian hernia (Latin: hernia Spigelii) is a rare type of abdominal hernia that occurs in the area known as the semilunar line (Spigelian line), which is a zone of weakness located laterally to the rectus abdominis muscle. Unlike the more common inguinal or umbilical hernias, Spigelian hernia develops deeper—under the muscular aponeuroses—making it difficult to diagnose clinically. It most often affects adults over the age of 40–50, more frequently women, and its development is associated with chronic increased intra-abdominal pressure, tissue weakening, and previous surgical procedures. Due to the high risk of incarceration, it is a condition that requires surgical treatment.
Spigelian hernia – what it looks like
A Spigelian hernia is located in the anterolateral wall of the abdominal cavity, most commonly in its lower segment, below the navel, in an anatomically weaker area where muscle fibers transition into aponeuroses. A characteristic feature is its subfascial position, meaning the hernia sac often does not form a distinct, visible bulge under the skin.
- located laterally to the rectus abdominis muscle,
- runs along the semilunar line,
- contents of the hernia sac may include:
- preperitoneal fat tissue,
- loops of the small intestine,
- a segment of the large intestine,
- the skin above the lesion usually does not show signs of inflammation or discoloration.
Due to its deep location, a Spigelian hernia is often invisible during a physical examination, especially in overweight or obese individuals. Often, the bulge becomes palpable or painful only during increased abdominal muscle tension (coughing, straining, lifting). In diagnostics, imaging studies play a key role, particularly dynamic ultrasound and computed tomography, which allow for an accurate assessment of the defect's size and its contents.
Spigelian hernia – symptoms
Symptoms of Spigelian hernia are often nonspecific and can develop gradually, which delays diagnosis. In some patients, the symptoms are intermittent and worsen in situations that increase intra-abdominal pressure.
- localized abdominal pain, located laterally, usually unilateral,
- a feeling of pulling, pressure, or burning in the abdominal wall,
- discomfort that worsens during:
- coughing,
- sneezing,
- physical exertion,
- prolonged standing,
- tenderness upon pressing the area of the hernia,
- occasionally palpable, hard lump under the fingers.
A particularly important clinical issue is the high risk of hernia incarceration, which occurs more frequently in Spigelian hernia than in other types of abdominal hernias. Symptoms suggesting incarceration or intestinal obstruction include:
- sudden, severe abdominal pain,
- nausea and vomiting,
- cessation of gas and stool passage,
- increasing tension and tenderness of the abdominal wall.
The occurrence of such symptoms is an emergency and requires urgent surgical intervention. For this reason, even a minimally symptomatic Spigelian hernia should not be treated conservatively.
Spigelian hernia - treatment
The only effective method of treating Spigelian hernia is surgical treatment. Conservative management is not applicable due to the lack of spontaneous closure of the defect and the high risk of complications, including incarceration and intestinal ischemia.
- reducing the contents of the hernia sac back into the abdominal cavity,
- closing the defect in the fascia,
- strengthening the abdominal wall at the site of weakness.
open surgery
- direct access to the hernia,
- possibility of using a synthetic mesh,
- method more commonly used in patients with complications or a large defect,
laparoscopic surgery
- less tissue trauma,
- shorter recovery time,
- better aesthetic outcome,
- precise assessment of the abdominal cavity from the inside.
In most cases, it is recommended to use alloplastic materials (meshes), which significantly reduce the risk of hernia recurrence compared to suturing native tissues. The choice of method depends on:
- the size and location of the defect,
- the age and general condition of the patient,
- the presence of comorbidities,
- the experience of the surgical team.
The postoperative period usually proceeds without complications. Temporary limitation of physical exertion, weight control, and avoiding factors that increase intra-abdominal pressure are recommended. The prognosis after a correctly performed procedure is very good, and the risk of recurrence is low.
