Spigelian hernia

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LATERAL ventral abdominal wall (spigelian) hernia protruding through the spigelian fascia should be considered in the differential diagnosis for the patient with otherwise unexplained abdominal wall pain. The symptoms associated with spigelian hernia are protean, unless incarceration has occurred. Vague abdominal discomfort and burning sensations, aggravated by heavy lifting, coughing, and exertion, are common and easily diagnosed as neuromuscular strain. The musculoaponeurotic defect is usually small and may be overlooked unless suspected and sought with appropriate maneuvers.

The spigelian semilunar line, named for Adriaan van der Spieghel (1578— 1625), Professor of Anatomy and Surgery at the University of Padua, represents the transition between the muscular and aponeurotic elements of the transversus abdominis muscle. The line begins at the attachment of the transversus abdominis at the eighth and ninth costal cartilages, curves most laterally near the umbilicus, and returns medially to its insertion at the pubic tubercle (Fig. 1). The spigelian fascia extends from the semilunar line to the lateral border of the rectus abdominis muscle and is a band that varies in width and strength. The posterior rectus sheath above the arcuate line of Douglas consists of the spigelian fascia and the posterior lamella of the internal oblique aponeurosis. Below the arcuate line, both of these layers advance anterior to the rectus abdominis, the arcuate line itself representing a variable point of transition of the majority of these fibers (Fig. 2).1

Spigelian hernia occurs through the attenuated spigelian fascia, characteristically above the inferior epigastric vessels and below the umbilicus and . . .



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