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ISSN: 1734-1922
Archives of Medical Science
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vol. 12
Letter to the Editor

Strangulation and necrosis of right hemicolon as an extremely rare complication of Spigelian hernia

Georgios Velimezis
Nikolaos Vassos
Georgios Kapogiannatos
Dimitrios Koronakis
Christos Salpiggidis
Evangelos Perrakis
Aristotelis Perrakis

Arch Med Sci 2016; 12, 2: 469–472
Online publish date: 2016/04/12
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Andrian van der Spigel was the first to describe the semilunar line, in 1645 [1]. The Spigelian aponeurosis is formed by the fusion of the aponeurosis of the internal oblique muscle and the aponeurosis of the transversus abdominis muscle. The linea semilunaris forms the lateral margin and the lateral edge of the rectus muscle the medial margin of the Spigelian aponeurosis. It extends from the costal cartilage of the 8th rib to the symphysis pubis [1–3]. In the upper abdominal wall, the Spigelian aponeurosis is posterior to the rectus muscle, making it difficult even for the experienced surgeon to locate a fascial defect during the physical examination. Superior to the umbilical region, the aponeurosis of the internal oblique crosses over the transverses, creating a strong abdominal wall barrier. Beneath the umbilical region the aponeurosis forms a weak barrier that is susceptible to protruding peritoneal sacs or extraperitoneal fat [1, 3–5]. Spigelian hernia was first reported by Klinklosch in 1764. More than half of all Spigelian hernias are located in a 6 cm wide region beneath the umbilicus and superior to the inferior epigastric vessels. This region is referred as “the Spigelian hernia belt” [1, 2]. The most common symptom of Spigelian hernia is pain (60%) due to contraction of the abdominal musculature. Another common symptom is a palpable abdominal mass in 35% of cases [6–17]. Predisposing factors were collagen disorders, age, obesity, rapid weight loss, multiple pregnancies, chronic pulmonary disease, trauma, iatrogenic causes and congenital disorders [3, 10, 18]. Once Spigelian hernia is diagnosed, there is a need for surgical treatment because of the high risk for serious complications. Emergency surgery is estimated to be performed in 21–33% of cases, due to incarceration and strangulation [2, 9–11, 15–22].
Here, we present a unique case of Spigelian hernia with incarceration and obstruction of the terminal ileum, appendix, cecum and right hemicolon that was treated with a major surgical procedure on an emergency basis.
A 70-year-old white female patient (body mass index: 34.2 kg/m2) referred to the Surgical Department of the Western Attica Hospital with abdominal pain in the right lower quadrant (RLQ), mild abdominal distention and progressive constipation. Her past medical history was significant for constipation symptoms, nausea and recurrent fever. Her past surgical history was not remarkable, and there was not a...

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