Spigelian Hernia

Submerged

Step 1: View clinicals

A 50 year old woman presents with recurrent episodes of pain in the left lower abdomen for 1 year. The pain did not worsen over time and was dull and aching in nature. It was worse on standing upright and walking while analgesics provided only poor relief. There was no history of urinary or gastrointestinal symptoms. Her medical and surgical histories are unremarkable.


Step 2: Order all relevant investigations

Ultrasound Abdomen

The ultrasound scan shows a hernia with a sac ring of 0.6cm in the lower left abdomen consistent with a spigelian hernia

CT Abdomen

The CT scan shows a hernial sac protruding through a defect in the left linea semilunaris, and containing mesenteric fat; this corresponds to the area of abdominal tenderness.

Colonoscopy

A colonoscopy will be arranged later in the week.

Urinalysis

Appearance: clear pH: 5.5 (4.5 - 8.0) Pus cells: 1-2/hpf (< 5) RBC: 0/hpf (< 3)


Step 3: Select appropriate management

Surgical repair
Antibiotics
Laxatives
High fibre diet


Score: ★★☆