Intestinal obstruction induced by a giant incarcerated Spigelian hernia: case report and review of the literature

CONTEXT: Spigelian hernia is an uncommon spontaneous lateral ventral hernia with an incarceration ratio of around 20%. However, complications such as intestinal obstruction are extremely rare. We report on a case of giant incarcerated Spigelian hernia with a clinical condition of complete intestinal obstruction that was treated using prosthetic polypropylene mesh. CASE REPORT: A 72-year-old woman was admitted to the emergency department complaining of diffuse abdominal pain. Abdominal examination revealed a firm 10 x 10 cm tender mass in the lower left quadrant, without surrounding cellulite or tenderness. Plain abdominal radiographs displayed the formation of levels, thus indicating the existence of intestinal obstruction. An abdominal computed tomography scan clearly showed a fluid and air-filled mass in the soft tissue area of the lower left-side abdominal wall. Spigelian incarcerated hernia was diagnosed and the patient underwent emergency surgical repair by means of local incision. The large defect in the abdominal wall was closed up as successive anatomical layers, and a prosthetic polypropylene mesh was set into the lateral aspect of the rectus sheath. The postoperative course was uneventful and the patient was discharged on the seventh postoperative day.