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Concept: Spigelian hernia

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Adriaan van den Spiegel (1578-1625) was a Flemish anatomist and physician. He was one of the most prominent anatomists at the University of Padua during the 17th century and became professor of anatomy and surgery there in 1619. He was privileged to have two of the most accomplished anatomists of that period, Fabricius ab Aquapendente and Iulius Casserius, as his teachers. His anatomical works were published after his death by his pupil Bucretius and his son-in-law Liberalis Crema, with illustrations procured from Casserius’s unpublished anatomical atlas. He contributed significantly to establishing basic morphological facts about the developing embryo in his text De formato foetu liber singularis. In his book De humani corporis fabrica libri decem, Spiegel’s lobe (caudate lobe) of the liver and the linea semilunaris (Spiegel’s line) on the lateral side of the rectus abdominis muscle were described for the first time. Subsequently, Spigelian aponeurosis (between the lateral margin of the rectus abdominis and the linea semilunaris) and Spigelian hernia (lateral ventral hernia) were named after him. He was a renowned physician in his time and was the first to give a detailed description of malaria. He made significant contributions as a botanist: the genus Spigelia, which has six species, is named after him. Clin. Anat., 2014. © 2014 Wiley Periodicals, Inc.

Concepts: Biology, Surgery, Liver, Physician, Hernia, Anatomy, Spigelian hernia, Adriaan van den Spiegel

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Abdominal hernias are common with over 20 million hernia repairs performed worldwide. Inguinal hernias are the most common type of hernia. Inguinal and sports hernia have been discussed at length in recent literature, and therefore, they will not be addressed in this article. The noninguinal hernias are much less common but do occur, and knowledge of these hernias is important when assessing the athlete with abdominal pain. Approximately 25% of abdominal wall hernias are noninguinal, and new data show the order of frequency as umbilical, epigastric, incisional, femoral, and all others (i.e., Spigelian, obturator, traumatic). Return-to-play guidelines need to be tailored to the athlete and the needs of their sport. Using guidelines similar to abdominal strain injuries can be a starting point for the treatment plan. Laparoscopic repair is becoming more popular because of safety and efficacy, and it may lead to a more rapid return to play.

Concepts: Surgery, Inguinal hernia, Hernia, Bowel obstruction, Hernias, Athletic pubalgia, Obturator canal, Spigelian hernia

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Spigelian hernia (SH) is a rare entity, but its surgical treatment is essential because of its high complication risk. Laparoscopic approaches have become the option in elective surgery because it has less morbidity and requires a shorter stay. Several laparoscopic techniques have been employed, but there is no gold standard technique for this kind of hernia. We report, in this study, our experience with intraperitoneal onlay mesh (IPOM) repair.

Concepts: Surgery, Hernia, Laparoscopic surgery, Laparoscopy, Hernias, Pediatric surgery, Elective surgery, Spigelian hernia

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Spigelian hernia (SH) is uncommon. Clinical diagnosis may be difficult, but computed tomography (CT) can help to establish the diagnosis. Laparoscopic repair is increasingly performed because it is associated with low morbidity rates. Laparoscopic approaches include transabdominal preperitoneal (TAPP), intraperitoneal onlay mesh (IPOM), and totally extraperitoneal (TEP). Here, we report our experiences of TEP repair for SH.

Concepts: Medical imaging, Evaluation methods, Hernia, Hernias, Spigelian hernia

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Spigelian hernias are a rare lateral ventral abdominal hernia that carry a high risk of strangulation due to their smaller sizes, and require surgical intervention. In more complex cases involving an anticoagulated patient, perioperative management of anticoagulation must be monitored and reviewed to avoid potential pitfalls. We present an 81-year-old woman who presented with right groin pain, and was requiring warfarin anticoagulation due to her cardiac history. The spigelian hernia was diagnosed and reduced laparoscopically, and the defect was repaired and reinforced by mesh. However, the patient suffered from catastrophic complications postoperatively related to her anticoagulation management. Spigelian hernias require surgical interventions. However, in an anticoagulated patient with significant comorbidities, perioperative anticoagulation needs to be closely monitored to balance the risk of thromboembolic disease with acceptable postoperative bleeding risks.

Concepts: Blood, Thrombosis, Surgery, Warfarin, Hernia, Anticoagulant, Hernias, Spigelian hernia

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Spigelian hernia (SH) is a rare entity accounting for 1-2% of ventral abdominal wall hernias. Elusive clinical signs and symptoms pose a diagnostic challenge and a consequent risk of strangulation. We present an emergent case of a Spigelian hernia involving the appendix.

Concepts: Symptom, Hernia, Medical sign, Hernias, Spigelian hernia

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Cancer of unknown primary (CUP) is a well-known entity that can present in a multitude of clinical presentations. Based on the extent and organ of involvement, the presentation will be varied. For instance, patients presenting with axillary lymphadenopathy would lead toward a primary breast cancer, whereas patients presenting with abdominal distention due to ascites would tend toward a gastrointestinal origin. We present a case of a 73-year-old female who presented with an abdominal wall mass; on laparoscopy, she was found to have a spigelian hernia due to an omental metastatic lesion from a CUP.

Concepts: Cancer, Breast cancer, Metastasis, Oncology, Chemotherapy, Hernia, Lymphadenopathy, Spigelian hernia

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Spigelian hernia represents a rare entity. Traditionally, it was repaired by the open technique. Various laparoscopic techniques have emerged periodically. Most laparoscopic repairs use the technique of placing an intraperitoneal onlay mesh (IPOM). There is currently a tendency to close the hernia defect.

Concepts: Surgery, Hernia, Hernias, Spigelian hernia

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Spigelian hernias are said to be a rare condition of the elderly population, usually arising below the arcuate line. Local experience has led us to challenge these commonly held beliefs.

Concepts: Sociology, Hernia, Hernias, Spigelian hernia

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We report an unusual case of an ectopic testis identified in a 37-year-old man presenting with acute severe right iliac fossa pain and an irreducible mass. Initially diagnosed as a Spigelian hernia, computed tomography and ultrasonography identified the presence of an ectopic testis in the abdominal wall. Interparietal testicular ectopia is an extremely rare condition. We present and discuss the first case in the literature of an ectopic testis located between the internal and external oblique muscle layers of the anterior abdominal wall in an adult.

Concepts: Hernia, Pelvis, Abdomen, Iliac crest, Right iliac fossa, Abdominal external oblique muscle, Testicular torsion, Spigelian hernia