A spigelian hernia is a hernia through the layer of tissue that separates two groups of abdominal muscles called the spigelian fascia. The muscles are called the rectus muscles and the lateral obliques.
This type of hernia is sometimes called a lateral ventral hernia. Spigelian hernias, unlike most types of hernias, do not develop below layers of fat but rather between muscles and the tissue that connects them.
READ ALSO: Sciatica: Symptoms, Causes and Treatment
A spigelian hernia can block a portion of the bowel or cut off the blood supply to other organs and tissue if left untreated. This condition can be life-threatening.
Pain caused by a hernia may temporarily improve for a protracted period. Once a hernia appears, the only way to fix it is through surgical treatment.
Spigelian hernias carry a high risk of complications, so it is vital to seek prompt medical care. Spigelian hernias are rare but occur more frequently in women than men, especially between the ages of 30 to 70.
Symptoms of Spigelian Hernia
It is hard to diagnose a spegelian hernia based on symptoms alone because the symptoms of a spigelian hernia can be similar to other hernias in the abdomen.
Spigelian hernias may not cause noticeable swelling because of their location between muscle layers. However, thin people with visible abdominal muscles may notice some swelling.
READ ALSO: Abdominal Pain
Most people with a spigelian hernia experience abdominal pain or elusive discomfort, especially when straining the abdominal muscles, such as when lifting or straining to have a bowel movement.
Some symptoms to watch for include:
- pain in the abdomen that may be unconnected to food, illness, or other common sources
- sudden changes in bowel function, such as constipationor a change in stool or bleeding
- abdominal pain when coughing or having a bowel movement
- unexplained swelling in the abdomen
Most people do not feel a swelling, and there does not need to be a perceptible swelling for there to be a spigelian hernia.
A spigelian hernia can occur on either side of the abdomen, but most people feel pain in the lower abdomen.
A spigelian hernia can block the bowel or other vital organs. When this happens, it becomes a deadly complication that requires immediate medical attention.
Symptoms of a blockage include:
- extreme abdominal pain that may come on suddenly or appear after a long period of less severe pain
- nausea and vomiting accompanied by severe pain
- not having a bowel movement for several days, especially if this is accompanied by intense stomach pain
- the appearance of blood in the stool
Causes of Spigelian Hernia
Spigelian hernias develop within a weakened area in the abdominal wall muscles.
A person can be born with the weakened area, or it can develop over time. If it develops over time, it can be because of an injury or increased pressure within the intestinal cavity. This weakened area allows tissue and organs to poke through the spigelian fascia.
Risk factors for a spigelian hernia include:
- a chronic cough, such as COPD
- frequently straining to have a bowel movement
- trauma to the abdomen, such as during surgery or due to a major injury
- frequently straining to lift heavy objects
- fluid in the abdomen due to conditions such as liver problems
- being overweight
- being pregnant
Diagnosing a spigelian hernia can be quite difficult, so it is essential to report symptoms to your doctor. An ultrasound or CT scan of the abdomen can help with a diagnosis.
It may also be useful to consult a general surgeon, as these experts have extensive knowledge of hernias, including spigelian hernias.
A spigelian hernia may also be discovered during surgery or procedures performed for other reasons, including:
- a bowel obstruction or blockage
- exploratory surgery
- surgery for another type of hernia
- gynecological surgery
- colonoscopy for colon cancerscreening
To diagnose a spigelian hernia, a doctor will take a complete medical history and will perform an exam to dismiss other medical issues.
Doctors also sometimes use computed tomography or CT scans. Both are safe and non-invasive diagnostic tests that allows a doctor to view the muscles, intestines, and abdominal wall.
If the diagnosis is not clear, a doctor may suspect that a hernia is present without knowing which type. They may decide to carry out exploratory surgery to locate and repair the hernia.
A spigelian hernia requires surgery for it to be repaired.
A minimally invasive surgery called laparoscopic hernia repair uses a small cut to guide a tube and a camera into the abdomen. With the assistance of the camera, doctors locate the hernia then use a mesh patch or stitches to repair the weakened abdominal wall.
A more invasive alternative involves a larger incision into the stomach. This surgery allows a doctor to directly visualize the hernia then make repairs to the damaged tissue.