A 40-year-old woman has a reducible tender lump in the left lower abdomen just above the inguinal ligament, lateral to the rectus muscle. CT shows herniation through a defect in the linea semilunaris near the level of the arcuate line. What is the diagnosis?

• A Spigelian hernia ✓
• B Direct inguinal hernia
• C Lumbar (Petit's) hernia
• D Epigastric hernia

Explanation

A Spigelian hernia passes through the spigelian fascia along the linea semilunaris, the curved lateral edge of the rectus sheath, almost always below the umbilicus at the level of the arcuate line where the posterior rectus sheath is deficient. Because the sac is interparietal, lying between the oblique muscles, the lump may be diffuse and the diagnosis frequently requires imaging. Lumbar hernias occur through Petit's triangle in the flank, and epigastric hernias pass through the midline linea alba.

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.