Laparoscopic Diagnosis of Incarcerated “Spigelian Hernia”
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Spigelian hernias are rare hernias, representing only about 1-2% of all abdominal hernias. An accurate preoperative diagnosis of this condition is often difficult because the physical presence of these hernias is often not demonstrable owing to its peculiar anatomic location. Many patients with Spigelian hernias, therefore, may have no obvious findings on clinical examination. The diagnosis is even trickier in obese patients wherein the hernia sac may lie in an intraparietal plane, masked by the abdominal subcutaneous fat. Here we describe a case of incarcerated Spigelian hernia where clinical and radiological findings were inconsistent and the accurate diagnosis was made by laparoscopy and was followed by a laparoscopic-assisted repair using an open anterior approach with an onlay mesh. We therefore feel that laparoscopy can be a useful tool for confirming the diagnosis and also for performing a definitive repair in doubtful cases of Spigelian hernias.

Case Report
A 45-year-old-woman presented with a history of sudden onset of right-sided lower abdominal pain since five hours and was associated with vomiting. She gave a history of recurrent episodes of right-sided lower abdominal pain since the past 2 years and several imaging studies done over this time period, including ultrasonography and computed tomography scans, failed to reveal the etiology of her symptoms. She had no previous surgical history, but was recently detected to have type 2 Diabetes Mellitus. Clinical examination revealed an obese abdomen with maximal focal tenderness in the right lower quadrant. However, a vague fullness was palpable in the lower right quadrant which corresponded to the site of maximal tenderness......