Concurrent Spigelian hernia and falciform ligament hernia in a 67-year-old female

Highlights

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  We present a case of a concurrent Spigelian hernia and internal hernia through the falciform ligament.

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  We discuss the clinical presentation and management of this case.

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  We suggest methods to decrease mortality from internal hernias such as a raised awareness and a laparoscopic approach for adequate internal examination of the abdominal contents.

Abstract

Introduction

Internal abdominal hernias account for 1% of all hernias but 5.8% of all bowel obstructions and hence are of significant clinical importance. Similarly Spigelian hernias account for only 0.12–2% of all abdominal wall hernias.

Case presentation

We present and discuss the management of a case that presented with concurrent falciform ligament internal abdominal hernia and Spigelian hernia. We believe this is the first reported case of such an occurrence in the literature.

Conclusion

Due to the advancements in computer topography (CT) imaging many internal and Spigelian hernias are diagnosed pre-operatively though these scan are not always available or indicated in cases of suspected small bowel obstruction. Due to the high mortality rate of undiagnosed internal hernias a high clinical suspicion must be maintained. The authors recommend laparoscopic trans-abdominal repair of Spigelian hernias in order to examine the abdominal contents and exclude rare, though potentially serious internal hernias.