A Case of Spigelian Hernia with Incarcerated Necrosis at Ascending Colon and the Perforation of Appendix, Case Report and Review of 56 Domestic Cases

An 86-year-old woman was referred for a right lower quadrant abdominal mass. Abdominal examination revealed a 10 cm hard mass with tenderness in the right lower quadrant. Abdominal CT indicated the absenceof aponeurosis at the lateral border of the rectus abdominis muscle and protrusion of the intestinal tractfrom the abdominal cavity. We suspected Spigelian hernia, because she had never undergone surgery. Weconducted emergency surgery, which showed a hernia sac under the thin external oblique aponeurosis and ahernia orifice of 5 × 3cm. The contents were the anterior wall of ascending colon and cecum with necrosis. Her appendix was inflamed and perforated. We excised the right colon, the appendix, and part oftheileum and suturedthe abdominal wall fascia. Immediately after surgery, she underwent septic shock, treated by endotoxinabsorption, and survived. Spigelian hernia is rare in abdominal wall hernia. This is, to our knowledge, the firstcase of intestinal resection and perforated appendicitis reported in Japan. We detailthis case of Spigelian hernia and review the literature.