Spigelian hernias cause dull pain in the lower abdomen and can be difficult to diagnose. Surgery is the usual treatment to prevent strangulation, with a mesh placed across the lesion to prevent future hernias. Symptoms can include bowel irregularities and a soft mass in the abdominal wall.
A spigelian hernia usually has minimal symptoms, with dull, intermittent pain in the lower abdomen being the most common. Diagnosing the condition can take time, as symptoms can be vague and it may be difficult to figure out what’s causing them. Treatment is usually surgery to repair the hernia and prevent strangulation, in which part of the intestine becomes trapped in the hernia and dies due to not getting enough blood. This surgery can be done by a general surgeon or a hernia repair specialist and is not usually an emergency procedure.
In a spigelian hernia, part of the muscular wall of the abdomen separates. Some patients have a small empty pouch in the separate space, while in others a bowel loop may slip. Sports activities, straining, pregnancy, existing weaknesses, and severe coughing or vomiting can all be potential causes of a spigelian hernia. Initially, the patient may notice a dull, persistent ache in the area, sometimes interrupted by sharper pain when bending, twisting, and heavy lifting.
Patients may also develop bowel irregularities in some cases, with diarrhea, constipation or changes in stool color. People with well-developed musculature and minimal abdominal fat sometimes see a small bump where the hernia sac is located, and it is also possible to feel a soft mass in the abdominal wall. This mass will often move with pressure and may appear intermittent in nature. All of these signs of a spigelian hernia can be useful diagnostic clues, and a medical imaging study will be requested to examine the abdominal wall and see if a hernia can be identified.
In some cases, intestinal strangulation occurs, leading to significant abdominal pain, stool changes, and problems such as nausea and vomiting. If strangulation develops, surgery is needed to correct it immediately to remove the diseased section of intestine before infection and other complications occur. During the surgery, the hernia will also be repaired to prevent future strangulation.
This type of hernia is relatively rare and can occur in people of all ages. In spigelian hernia repair surgery, a doctor will place a mesh across the lesion, preventing the contents of the abdomen from protruding through the hernia. This also gives the tissue a chance to stitch back together, sealing the tear, and the mesh will prevent future hernias in that location. Patients may experience severe postoperative pain and will need to refrain from strenuous physical activity for several weeks following surgery to give the site time to heal.
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