A Case of Spigelian Hernia with Incarcerated Necrosis at Ascending Colon and the Perforation of Appendix, Case Report and Review of 56 Domestic Cases

Yoshihiko Nakamoto, Tomoko Nonomura, Takehisa Harada, Masahiko Takeo, Masaaki Ogata, Mitsuo Yamamoto and Hiroshi Aoyama

Department of Surgery, Kobe Nishi City Hospital

An 86-year-old woman was referred for a right lower quadrant abdominal mass. Abdominal examination revealed a 10 cm hard mass with tenderness in the right lower quadrant. Abdominal CT indicated the absence of aponeurosis at the lateral border of the rectus abdominis muscle and protrusion of the intestinal tract from the abdominal cavity. We suspected Spigelian hernia, because she had never undergone surgery. We conducted emergency surgery, which showed a hernia sac under the thin external oblique aponeurosis and a hernia orifice of 5×3 cm. The contents were the anterior wall of ascending colon and cecum with necrosis. Her appendix was inflamed and perforated. We excised the right colon, the appendix, and part of the ileum and sutured the abdominal wall fascia. Immediately after surgery, she underwent septic shock, treated by endotoxin absorption, and survived. Spigelian hernia is rare in abdominal wall hernia. This is, to our knowledge, the first case of intestinal resection and perforated appendicitis reported in Japan. We detail this case of Spigelian hernia and review the literature.

Key words
Spigelian hernia, incarceration, appendicitis

Reprint requests
Yoshihiko Nakamoto Department of Surgery, Kobe Nishi City Hospital
2-4 Ichibancho, Nagata-ku, Kobe City, 653-0013 JAPAN

Accepted
October 29, 2003

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