Hernias happen when there's an abnormal bulging of an organ or part of an organ through a weakness or gap in its containing wall. A spigelian hernia is a rare kind that's often difficult to diagnose.
Knowing more about this condition, its causes, and its symptoms will make it easier to discuss with your doctor early on if you've been feeling any pain or discomfort. Early diagnosis and treatment can spare you from dangerous complications.
What Is a Spigelian Hernia?
The spigelian fascia is a layer of tissue that separates the two muscle groups at the front of your abdomen. When a slit-like opening occurs in this fascia, it's called a spigelian hernia.
This condition usually affects the intestines and omentum, a layer of tissue that lies over the abdominal organs. The caecum, the appendix, and other organs can also be affected by a spigelian hernia.
Spigelian hernias make up 0.12% to 2% of abdominal wall hernias. They're much less common than inguinal or femoral types.
What Causes a Spigelian Hernia?
Like other hernias, the spigelian type is mainly caused by an opening or a weakness in the abdominal wall. Other common causes include:
- Long-standing medical conditions that increase abdominal pressure, like chronic coughing, liver cirrhosis with fluid collection (ascites), pregnancy, and obesity
- Any weakness of the abdominal wall muscles brought on by aging, for example, or disease
- Constipation, with prolonged straining
- An injury to the abdomen
Spigelian hernias are most common after age 50. They usually happen in the lower part of the abdomen.
What Does a Spigelian Hernia Feel Like?
If you feel a small, soft lump or bulge on your abdominal wall, you may have a spigelian hernia. Typically covered by fat, this lump or bulge is often painless and more noticeable when you are standing. The size itself, though, often increases and decreases on its own.
Having this type of hernia might also cause:
- Pain in your abdomen, not related to meals or illness
- Pain that increases while straining to cough, for example, motioning to pass something, or lifting something heavy
- A change in your bowel habits, like constipation
- Blood in your stools
How Is a Spigelian Hernia Diagnosed?
Because spigelian hernias are small, difficult to feel, and don't have specific symptoms, they're often difficult to diagnose. Your doctor may want to examine you standing up to better find it. They may also ask you to breathe out forcefully while keeping your mouth and nose closed, performing a breathing method known as the Valsalva maneuver. This causes an increase in abdominal pressure that helps your doctor detect the hernia.
This doesn't mean your doctor will be able to find it, though. Because spigelian hernias happen within an abdominal muscle, they're much harder to feel. When this happens, they're usually diagnosed when a severe complication happens.
If your doctor suspects that you have a spigelian hernia, they will ask you to get an ultrasound or computed tomography scan (CT scan). These imaging methods usually diagnose the hernia.
Is a Spigelian Hernia Dangerous?
Spigelian hernias usually have the omentum, or intestines, passing through a narrow opening. Because the slit through which the spigelian hernia passes has rigid borders, the omentum or intestines may get stuck. If that happens, any of the following complications can arise:
- Incarceration. This happens when part of the intestine or abdominal tissue gets trapped in the hernia's sac. Incarceration occurs in 27% of spigelian hernia cases.
- Obstruction. When a loop of the intestines gets stuck in a narrow opening, the contents cannot move ahead. Undigested food collects above the incarcerated point.
- It becomes a strangulated hernia. This happens when the intestine gets stuck through a narrow opening and the blood supply is blocked. Without a proper blood supply, the tissues will die.
All these complications are life-threatening and require immediate treatment. Seeking medical attention as soon as possible if you think you have them.
What Is the Treatment for a Spigelian Hernia?
Surgery is the only way to treat a spigelian hernia, either by a regular surgical operation or through laparoscopic repair. Waiting isn't a good idea because the hernia won't get better on its own.
During regular surgery, your doctor will identify the gap in the spigelian fascia and will push the omentum or intestine back into the abdomen. After that, they'll close the gap by sewing it up or placing a mesh over it.
With laparoscopic repair, your doctor will only need to make one or two small incisions to your body. Your hospital stay will likely be shorter and so will your recovery time.
You should plan for surgery as soon as your spigelian hernia is diagnosed. You may need emergency surgery if incarceration, obstruction, or strangulation happens. Spigelian hernia treatment is safest when done early as planned surgery.