Working Diagnosis:
Spigelian hernia

Treatment:
The patient underwent laparoscopic repair of the spigelian hernia. Case Photo #3

Outcome:
At six months post-operative the athlete’s pre-operative pain returned. The athlete underwent surgical revision and successful repair. The patient was allowed to return to activity as tolerated.

Editor's Comments:
Spigelian hernias are a rare cause of abdominal hernias given that they only account for one to two percent of hernias arising from the abdominal region1. They typically occur when there is weakness with oblique musculature and the fascia near the semilunar line leading to defect through the transversus aponeurosis2. This diagnosis can be difficult to make given that there are no specific symptoms that will point to the diagnosis. Though uncovering this hernia can be difficult; prompt diagnosis is required given the risk of strangulation is significant1. Diagnostic musculoskeletal ultrasound is a valuable tool when evaluating hernias and has the unique advantage of allowing the user to perform dynamic movements during the examination that cannot be performed with computerized tomography or magnetic resonance imaging3.

References:
1. Noomene R, Bouhafa A, Maamer AB, Haoues N, Oueslati A, Cherif A. Hernies de Spiegel [Spigelian hernias]. Presse Med. 2014 Mar;43(3):247-51. French. doi: 10.1016/j.lpm.2013.06.029. Epub 2014 Jan 16. PMID: 24439537.
2. Mittal T, Kumar V, Khullar R, et al. Diagnosis and management of Spigelian hernia: A review of literature and our experience. J Minim Access Surg. 2008;4(4):95-98. doi:10.4103/0972-9941.45204
3. Stavros AT, Rapp C. Dynamic ultrasound of hernias of the groin and anterior abdominal wall. Ultrasound Q. 2010 Sep;26(3):135-69. doi: 10.1097/RUQ.0b013e3181f0b23f. PMID: 20823750.

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