A hernia through the spigelian semilunar line (an anatomic site named after Professor van der Spiegel) is termed a spigelian hernia. Most occur spontaneously. It may be misdiagnosed if the physician is unfamiliar with the condition.


This is a lateral ventral hernia localized to the spigelian fascia, which lies between the rectus abdominus and the semilunar line. Most occur below the level of the umbilicus.


Clinical findings:

(1) mild pain or vague abdominal discomfort

(2) symptoms may be increased by coughing, straining or exertion

(3) episodes of intestinal gurgling may be noted

(4) a lump may be present in the abdominal wall, or the hernia may be hidden by the external oblique aponeurosis

(5) intermittent intestinal obstruction may occur, with the potential for bowel incarceration or strangulation


Clinical findings on physical examination may be obscured if the patient is obese.


Differential diagnosis:

(1) acute appendicitis

(2) other types of hernia

(3) cholecystitis

(4) ovarian disorder


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