Spigelian Hernia

Spigelian hernia, also known as the lateral ventral hernia, is a hernia type that develops between the muscles and the fascia through Spigelian aponeurosis. Without treatment, a Spigelian hernia can damage other organs and tissues by blocking the flow of blood to them.

Below, we take a look at what Spigelian hernia is, its causes, and potential treatment options in detail. 

What Is Spigelian Hernia

Spigelian fascia is the aponeurotic layer that begins medially and ends laterally at the semilunar line and connects the rectus abdominis muscle. A Spigelian hernia happens when there's a slit-like defect in the anterior abdominal wall. Hernias caused by spigelians happen mostly in the lower abdomen.

This type of hernia is also called “spontaneous lateral ventral hernia” or “hernia of semilunar line”. 

What Causes Spigelian Hernia

Spigelian hernias develop when there is a weakened spot in the abdominal wall muscles.

In some people, the weakened area is inborn, but in others, it develops over time. Below are mentioned a few causes that can lead to the development of this weak spot later in life. As a result of this weakening, tissues and organs can protrude through the Spigelian fascia, resulting in a bulge.

• Medical conditions that lead to increased abdominal pressure, like obesity, pregnancy, and prolonged coughing
• Abdomen injury
• Weakness in the abdominal muscles caused by aging

In spite of the rarity, anyone can suffer from a Spigelian hernia. There are, however, some people who are more at risk. Men over 50 are more likely to develop these types of hernias. 

Symptoms of Spigelian Hernia

People with spigelian hernia can feel a lump or bulge in their abdominal wall. The bulge is typically visible when you are standing or engaging in any physical activity. 

The most common symptom of a spigelian hernia is abdominal pain, particularly when straining the abdominal muscles, like lifting or going to the bathroom.

Watch out for these symptoms:

• Prolonged pain in the stomach
• Bleeding or constipation following a sudden change in bowel function
• Blood in stool
• Pain in the abdomen when engaging in physical activities like lifting
• Intestinal swelling

In some cases, this type of hernia can block the blood flow to the vital organs of the body. There are several symptoms of this condition, which can be life-threatening if not treated immediately:

• Intense, sudden abdominal pain
• Prolonged nausea and vomiting
• Persisting constipation accompanied by stomach pain
• Blood in stool

If you face one or more of these symptoms, it is highly recommended to visit your doctor immediately. Waiting can lead to serious issues that may be more difficult to treat.

Diagnosis

If you suspect a hernia, you should immediately see your doctor. The diagnosis of a hernia is made after a physical examination. However, your doctor will ask about your medical history and if you have been experiencing any symptoms of a hernia prior to that examination.

Alternatively, they might ask you to perform a breathing technique called the Valsalva maneuver, in which you forcefully exhale while keeping your mouth and nose closed. A rise in abdominal pressure allows your doctor to detect the hernia.

The healthcare professional might also recommend the following test to diagnose the hernia if a physical examination is not enough:

• Ultrasound - In this method, sound waves are used to create images of your body's structures. These images are then used to diagnose the problem and pick a relevant treatment.
• CT scan - A CT scan produces images of your body's cross-section using X-rays. In this procedure, doctors can see detailed images of your bones, muscles, organs, and blood vessel.

Because spigelian hernias have rigid borders, the intestine or omentum can become stuck in the narrow opening through which the hernia passes. When this happens, it can lead to the following complications:

• Incarceration - The hernia sac becomes entrapped with part of the intestine or abdominal tissue.
• Obstruction - 
• When a loop of the intestines gets stuck in a narrow opening, the contents cannot move ahead. Undigested food collects above the incarcerated point.
• Strangulated hernia - This happens when the intestine gets stuck through a narrow opening, and the blood supply is blocked. Without a proper blood supply, the tissues will die.

Once the hernia is diagnosed, the doctor will recommend treatment according to your situation.

Treatment

Depending on the severity of your Spigelian hernia, your doctor will recommend treatment. If the size of the hernia is small, your doctor may recommend observing it until further action is needed, but hernias are treated only by surgery.

Here are the different surgery options available:

• Open Repair Surgery - this is the longest-standing treatment for hernias, and it involves making incisions in the groin area, through which the hernia is pushed back into position. Stitches and synthetic mesh are used to strengthen abdominal muscles. It takes about three weeks to recover from an open repair surgery. It will take about six weeks for the patients to resume their regular physical activity.
• Laparoscopy - The procedure requires several small incisions in the lower abdomen, and a camera-equipped device called a laparoscope is inserted through them. Through other incisions, small instruments are inserted to repair the hernia. This new method of treating hernias offers faster recovery.

Once you have been diagnosed with spigelian hernia, you should schedule surgery as soon as possible. Delaying the surgery may lead to incarceration, obstruction, or strangulation, which can be life-threatening.