Anterior abdominal wall swelling as incarcerated Spigelian hernia in an elderly female: A diagnostic dilemma

Spigelian hernias are difficult to detect and palpate during physical examination due to their deeper location. They can be asymptomatic or present with acute complications such as incarceration, strangulation, or bowel obstruction. Here we present a case of a 58-year-old female with history of palpable swelling over the left iliac fossa region with abdominal distension. A computed tomography with oral contrast revealed features suggestive of incarcerated Spigelian hernia with small bowel obstruction, which was later managed with laparoscopic ventral hernia repair and repair of seromuscular tear of the small bowel. Computed tomography is the gold standard for diagnosing the condition and assessing bowel status. Conservative treatment is not effective due to the high likelihood of complications, and surgery is the mainstay of management. The approach to surgery depends on the patient's characteristics, the type of hernia, and the surgeon's experience. Mesh repair is advocated regardless of approach.