A Case of Spigelian Hernia due to Blunt Trauma

Manabu Tsukada, Takuro Saito, Takao Tsuchiya, Yoshihiro Satoh, Akira Kenjo, Atai Satoh, Tsuyoshi Abe and Mitsukazu Gotoh

Department of Surgery I, Fukushima Medical University School of Medicine

A acute traumatic abdominal hernia is rare and a Spigelian hernia is uncommon in the anterior abdominal wall. We report a case of Spigelian hernia caused by a traffic accident. A 20-year-old man, in a motor vehicle crash, was hemodynamically stable on arrival at the emergency department. Physical examination showed a fractured left femur, an irreducible 5.0×3.0 cm bulge in the left lower abdominal quadrant, and an avulsion of the musculature in the right lower abdominal quadrant with oppressive pain. Abdominal computed tomography (CT) showed a central rupture of the liver, fracture of the lumbar bone, and ruptures of the left and right lower abdominal wall with a herniated small intestine. We diagnosed the abdominal wall bulge as a traumatic Spigelian hernia and reduced the incarcerated hernia. Because of the hemodynamically stable condition, observation was elected to treat the central liver rupture. The man required 3 months of the bed rest for the fractures of the lumbar bone and left femur. During this time, the abdominal hernia shrank, finally healing after 3 month. Physical examination showed no bulge and no avulsion in the upright and standing positon, and no herniation was confirmed by abdominal CT or ultrasonography. He did well in follow-up without recurrence of hernia at 9 month after the trauma.

Key words
acute traumatic abdominal hernia, Spigelian hernia

Reprint requests
Mitsukazu Gotoh Department of Surgery I, Fukushima Medical University School of Medicine 1 Hikarigaoka, Fukushima, 960-1295, JAPAN

Accepted
February 26, 2003

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