Incarcerated Spigelian hernia: a rare cause of ileus

Background: First described in 1764, the hernia of the semilunar line is called a Spigelian hernia. Spigelian hernias are rare: comprising only 1-2% of all abdominal hernias.

Methods: A 73-year-old man presented at the emergency department complaining of not having defaecated and swelling of the right lower abdomen. This proved to be ileus caused by an incarcerated Spigelian hernia. The patient underwent surgery at which the hernia was reposited at an open procedure and repaired with a mesh mat. The patient quickly recovered.

Conclusions: Spigelian hernias are located in the aponeurosis of the transverse abdominal muscle and internal oblique muscle. Diagnosis can be challenging; often the hernia is covered by the aponeurosis of the external oblique muscle. Because of the high risk of strangulation, operation is almost always indicated.