Pitfalls and Pearls Obtained from a Case of Strangulated Spigelian Hernia Repair

Abstract

Strangulated Spigelian hernia is an uncommon abdominal emergency. This condition requires open emergency surgery, which often involve bowel resection. Here I have described a case of strangulated right sided Spigelian hernia with gangrenous small bowel. The surgery was conducted through a lower abdomen transverse incision with small bowel resection and anastomosis. The hernia defect was closed with tension free Darning’s repair. Post operative day 4, the abdomen was reexplored as patient had signs of intestinal obstruction. Intraoperative findings showed distal small bowel kinking with anastomosis dehiscence. Lessons learnt from this case highlights the importance of adherence to general principles of emergency surgery such as, choice of abdominal incision, safe method of hernia closure, prevention of intraperitoneal adhesion and safety of bowel anastomosis in emergency surgery.