A 45-year-old woman presents with a reducible tender swelling just above the inguinal ligament, lateral to the rectus muscle, which is more apparent on standing. CT shows a defect in the linea semilunaris below the umbilical level. The diagnosis and underlying anatomical reason are:

• A Umbilical hernia, occurring through a patent umbilical ring
• B Spigelian hernia, occurring where the semilunar line lacks posterior rectus sheath below the arcuate line ✓
• C Divarication of recti, occurring from midline aponeurotic stretching
• D Femoral hernia, occurring through the femoral canal below the ligament

Explanation

B Spigelian hernia passes through the linea semilunaris at the lateral edge of the rectus sheath, classically at the level of the arcuate line where the posterior rectus sheath is deficient and only transversalis fascia supports the abdominal contents. It is usually small, interparietal, and easily missed clinically, so ultrasound or CT confirms it. Its position above the inguinal ligament and lateral to the rectus excludes femoral and umbilical hernias.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.