Male Patient having a Spigelian Hernia, Prince Osman Digna Referral Hospital, Port Sudan City, Red Sea State, Sudan; 2024: A Case Report

Background: Spigelian hernia is a rare type of abdominal hernias; it occurs through a defect in Spigelian aponeurosis of transverse abdominis (Spiegel's fascia). Methods: A 65 years old male, presented to our refer clinic at Prince Osman Digna Referral Hospital; Port Sudan City; Red Sea State; Sudan, on July 2024, complaining of lower abdominal swelling for 2 months without features of obstruction or strangulation; following heavy lifting, obvious during standing and walking, disappear when lying down; and was not associated with gastrointestinal track disturbances. Patient had history of recurrent repaired right inguinal hernia, para-umbilical hernia, and transurethral resection prostatectomy for Benign Prostatic Hyperplasia. No family history of similar conditions. Result: Abdominal examination showed: positive visible cough impulse revealed reducible mass at the left lower abdomen, oval in shape about 15*15cm, without features of peritonism. CT abdomen showed: left lower lateral abdominal wall hernia defect lateral to the rectus abdominis muscle measuring (3*3.7 cm) with hernia sac lie between the external and internal oblique muscles containing bowel loops. Patient diagnosed as Spigelian hernia and planned for mesh hernioplasty. Intra-operative findings revealed: the hernia sac passed through the internal oblique and transverse abdominis muscles, it contained sigmoid colon which released smoothly, sac excised, external oblique aponeurosis sutured by nylon 2, prolene mesh fix onlay, no intraoperative complications. Post-operative course was smooth. Conclusion and recommendations: Spigelian hernia has to be suspected among patients having repeated abdominal hernias. Early diagnosis using CT Abdomen and urgent surgical intervention for such cases were highly recommended.