A differential diagnosis in chronic lower abdominal pain.

Spigelian hernias represent 0.12-2.4% of all abdominal wall hernias. Its diagnosis is elusive and requires a high level of conjecture given the disease rarity, vague associated abdominal complaints and frequent lack of consistent physical findings. A 60-year-old woman presented with a history of chronic pain in the left lower side of the abdomen. The patient was treated for several diseases with no relief of symptoms. Abdominal ultrasound showed a Spigelian hernia in the lower left abdomen and surgery was scheduled for treatment. A SH is generally an inter-parietal hernia, meaning that the pre-peritoneal fat and the hernia sac penetrate the trasnversus abdominis and internal oblique muscles but remain behind the external oblique aponeurosis. In most of the patients the lack of clinical signs demands radiological investigation. That's the importance of the high grade of suspicious of the disease during the physical exam. The surgical repair is necessary due to the high risk of incarceration-related complications which can occur in up to 21% of cases. It's important to think in the Spigelian hernia as cause of lower abdominal pain to prompt indicate surgical repair and provide the patient's symptom relief. Also the type of repair is dependent on the surgeon's choice and also the means available in each center. Copyright © 2012 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Citation

Marcos Duarte Siosaki, Márcia Maria Hagge Coelho Costa, Higino Felipe Figueiredo, Messias Froes da Silva Junior, Rubem Alves da Silva Junior. A differential diagnosis in chronic lower abdominal pain. International journal of surgery case reports. 2012;3(10):504-6

PMID: 22858791

search → result