Spigelian Hernia - A Diagnostic Dilemma

Spigelian hernia is a surgical rarity which occurs through slit-like defects in the anterior abdominal wall. It has been estimated that it constitutes 0.12 of abdominal wall hernias. Since there are no specific symptoms and signs the diagnosis is difficult. We report a case of Spigelian hernia in a 24-year-old female who presented with recurrent abdominal pain in the left paraumbilical region since one year. Abdomen examination showed no obvious swelling or tenderness. USG abdomen showed a left para-umbilical defect measuring 4.7 cms with bowel as hernia content. Through a left oblique incision external oblique was opened. A hernia was seen sticking out from the lateral margin of the rectus abdominis. The hernia contained a part of the greater omentum which was reduced. The fascial defect was closed with non-absorbable suture S in layers with onlay mesh. Spigelian hernia is rarely encountered and it is difficult to make a diagnosis as there is a risk of strangulation and early surgical intervention is advised.