A spigelian hernia is a unique type of hernia in that it usually develops within connective tissue, but not below layers of fat.
Sometimes referred to as a lateral ventral hernia, a spigelian hernia develops due to a weakness within a layer of tissue that divides abdominal muscles, known as the spigelian fascia. Considered rare, spigelian hernias tend to affect women more than men.
Because of the high complication risk associated with hernias like this, it's important for patients to seek treatment as soon as possible.
Causes, Risk Factors, and Symptoms
It's usually a weakness in the abdominal wall that provides the perfect environment for a spigelian hernia to develop. Depending on the size of the hole, both tissues and organs may protrude. Abdominal trauma or injury, lifting heavy objects, excess abdominal fluid, obesity, pregnancy, and underlying health issues like allergies or bronchitis that tend to trigger forceful sneezing or coughing are some of the factors that could contribute to this type of hernia. Symptoms related to a spigelian hernia may include:
- A visible lump or bulge just below or next to the belly button
- Abdominal swelling or tenderness, especially in thinner people
- Discomfort that's noticeable or more bothersome during difficult bowel movements or movements involving abdominal straining
- Vague symptoms not related to eating or other common sources of stomach or abdominal pain
- Unexplained changes in bowel movements
Immediate treatment should be sought if symptoms suggest that a spigelian hernia is causing a bowel obstruction. Signs this may have happened include unbearable abdominal pain, blood in stool, pain combined with nausea and vomiting, and failure to have a bowel movement for several days coupled with severe stomach pain.
Signs and Symptoms
Some men experience no signs or symptoms of their inguinal hernia. Others are aware they have a hernia, but experience little or no pain or discomfort from it. Conversely, some men suffer with groin pain, especially when lifting, straining, coughing, or bending over. A noticeable bulge may develop in the groin that disappears when lying down. Other symptoms include:
- Weakness, heaviness, or burning near the area of the bulge
- Swelling in the scrotum and testicles
Usually, an inguinal hernia is not serious or life-threatening. With gentle pressure, the herniated portion of the tissue or organ should slide back into its rightful place. However, if the hernia becomes trapped (incarcerated), this may become a medical emergency. If the incarcerated hernia loses its blood supply, the hernia is said to be strangulated, requiring immediate surgery to correct the problem. Symptoms of a strangulated inguinal hernia include nausea, vomiting, fever, a sudden, drastic increase in pain, a color change to the herniated area, or the inability to pass gas or move the bowels.
Diagnosis
Medical practitioners can often diagnose an inguinal hernia by studying a patient’s past medical history, reviewing current symptoms, and conducting a thorough physical examination. Often, a male may be asked to stand and cough or strain, with the examiner searching for bulges in the groin. Diagnostic imaging is usually not needed unless the physical examination is limited or if there is a suspicion for incarceration or strangulation of the hernia. In this case, abdominal X-rays or CT scans may be necessary.
Treatment Options
If the hernia is small, easily be pushed back into place, and not causing much discomfort, careful monitoring may be all that is needed. However, due to the risk of strangulation, most inguinal hernias are surgically repaired. Surgical options include an open hernia repair (herniorrhaphy), laparoscopic hernia repair, or robotic hernia repair.