A Spigelian hernia is a rare form of abdominal wall hernia that develops along the semilunar line, close to the lateral edge of the rectus abdominis muscle.
A hernia that hides
Unlike umbilical or inguinal hernias, it can be difficult to recognise because it often develops between the muscle layers, without causing an obvious swelling.
What are the symptoms?
A Spigelian hernia may present with:
- Localised pain or discomfort in the side of the abdomen.
- Intermittent swelling, more noticeable during effort or when standing.
- A feeling of tension or heaviness in the abdomen.
- In some cases, no obvious symptoms.
How is it diagnosed?
Examination and dynamic ultrasound
Diagnosis is based on a surgical examination, often combined with dynamic ultrasound of the abdominal wall.
CT in doubtful cases
In doubtful cases, especially when the hernia is small, an abdominal CT scan may be indicated to define the location and characteristics of the defect.
How is a Spigelian hernia treated?
Definitive treatment is surgical, because the fascial defect cannot close on its own or be corrected with exercises or physiotherapy.
- It does not close on its own
- Exercises do not correct it
- Physiotherapy does not correct it
When indicated, surgery can be performed with minimally invasive laparoscopic or robotic techniques, which make it possible to repair the defect and reinforce the wall with a mesh that remains extraperitoneal
When should you see a surgeon?
Specialist assessment
A specialist assessment is advisable in the presence of persistent lateral abdominal pain, intermittent swelling or a suspected Spigelian hernia.
Emergency department
Sudden, severe pain, a swelling that cannot be pushed back, vomiting or signs of bowel obstruction require urgent assessment in the Emergency Department.
Do you suspect a Spigelian hernia?
A specialist assessment makes it possible to confirm the diagnosis and identify the most appropriate treatment, including minimally invasive techniques.
Dr Gabriele Manetti · Specialist in General Surgery
Frequently asked questions
What are the symptoms of a Spigelian hernia?
It can cause localised pain, discomfort during effort or an intermittent bulge. In some cases no swelling is visible, because the hernia stays between the muscle layers.
How is a Spigelian hernia diagnosed?
Diagnosis is based on a surgical examination and can be confirmed with dynamic ultrasound of the abdominal wall. In doubtful cases, CT makes it possible to identify the defect and assess its anatomical characteristics.
Can a Spigelian hernia heal without surgery?
No. The fascial defect does not close with exercises, physiotherapy or medication. Anatomical repair is surgical and, after specialist assessment, planned treatment is generally recommended.
Can a Spigelian hernia be operated on laparoscopically?
Yes. Minimally invasive laparoscopic or robotic techniques can be used to repair the defect and place a mesh.