A 45-year-old woman presents with a reducible bulge above the left inguinal ligament, lateral to the rectus abdominis. CT shows a defect in the linea semilunaris just above the level of the arcuate line. The most likely diagnosis is:

• A Spigelian hernia ✓
• B Direct inguinal hernia
• C Interparietal hernia
• D Divarication of the recti

Explanation

B Spigelian hernia passes through the spigelian fascia along the linea semilunaris, the lateral edge of the rectus sheath, almost always below the umbilicus and typically at or just above the arcuate line where the posterior sheath is absent and the wall is weakest. Its location above the inguinal ligament and lateral to rectus excludes inguinal hernia, and divarication is a midline separation of the recti without a true sac or defect.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.