A 50-year-old woman presents with a tender, irreducible bulge in the left lower abdomen just lateral to the rectus muscle, below the umbilicus. CT shows a defect in the linea semilunaris at the level of the arcuate line with a small neck. Which complication is this hernia particularly prone to?

• A Chronic groin sinus from mesh erosion
• B Spontaneous rupture into the peritoneal cavity
• C Malignant transformation of the sac
• D Strangulation, because of its narrow neck ✓

Explanation

This is a Spigelian hernia, occurring through the linea semilunaris at the junction of the semilunar line and the arcuate line, where the posterior rectus sheath is absent. The defect is small with a firm fibrous edge, so although the hernia is often small and reducible, the incidence of incarceration and strangulation is disproportionately high, and elective repair is advised once diagnosed. Diagnosis is frequently delayed because the sac lies beneath the intact external oblique aponeurosis, making the lump poorly defined clinically.

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.