Rare, Spiegel’s hernia is one of the abdominal hernias since it develops at the expense of the line of Spiegel, an anatomical area located on either side of the abdominal wall. Asymptomatic for a long time, this lateral ventral hernia often suffers from a delay in diagnosis…
1. What are the manifestations of Spiegel’s hernia?
Spiegel’s hernias can occur at any age, although there is a peak incidence between 40 and 70 years. In addition, both sexes are equally affected by this type of protrusion which develops mainly between the front external oblique muscle and the rear internal and transverse oblique muscle, i.e. the famous semilunar line of Spiegel. Depending on the case, the hernia sac can contain different sections of surrounding organs such as the small intestine, the omentum or the appendix (The Pan African Medical Journal). However, the clinical signs generated remain uncharacteristic and are essentially limited to discomfort felt in the lower abdomen, or even to some transit disorders. It happens, much more rarely, that an anatomical arch appears as a result of physical exertion or the carrying of a heavy load. The first characteristic clinical signs occur when the hernia is strangulated. This is a dreaded complication that requires emergency treatment.
2. How is Spiegel’s hernia diagnosed?
Early detection of this lateral ventral hernia is difficult, because the protrusion causes little or no conclusive symptoms. Many people do not consider it necessary to consult for simple abdominal discomfort. In fact, strangulation is a frequent diagnosis of Spiegel’s hernia. Almost one in five cases is, in fact, discovered at this stage of complication (The Pan African Medical Journal). When the hernia sac is large, abdominal palpation is generally sufficient for the practitioner to detect a dehiscence, but this is not always the case. It is therefore necessary to resort to medical examinations, such as ultrasound and computed tomography, which will provide valuable information on the content and exact location of the hernia.
3. What is the treatment for Spiegel’s hernia?
Unlike some hernias that can be reduced manually, Spiegel’s hernia must undergo surgery (The MSD Manual). Thanks to technical progress, laparotomy has gradually been abandoned in favor of the laparoscopic route, which allows faster recovery of patients. However, the midline laparotomy is still practiced in case of strangulation of the hernia, because the technique offers easier access to the hernial sac. To limit recurrences, the persons concerned must adopt lifestyle and dietary measures in order to lose weight if necessary, overweight and obesity representing major risk factors.
Sources
The MSD Manual, The Pan African Medical Journal
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