G Chir Vol. 27 - n. 11/12 - pp. 433-435 Novembre-Dicembre 2006 Spigelian hernia: a case report and review of the literature A.M. ANGELICI, A.G. NASTI, N. PETRUCCIANI, G. LEONETTI, P. PALUMBO 433 Introduction Spigelian hernia, or lateral ventral hernia, is a rare de- fect of the abdominal wall, occurring through the Spige- lian aponeurosis (1-3); peritoneal sac or organ or prepe- ritoneal sac can protrude through the hernial orifice (4). It was already known and first described by De Blegny in 1860, Le Dran in 1742 and Le Clause in 1746. Klinkosh in 1764 gave to this hernia the defi- nitive nosologic and topographic arrangement and named it Spigelian hernia, after a Belgium anatomi- st, Adriaan Von Spieghel, who first described the li- nea semilunaris. It has been described in literature also with other names: joint tendon hernia, ventral interstitial hernia, semilunar line hernia and lateral ventral hernia (5, 6). Spigelian hernia is infrequently referred to in the worldwide literature: Spangen’s review in 1993 gathe- red 979 published cases (7); later other authors have added new cases usually in short series (8). Linea semilunaris represent the border zone between muscular and aponeurotic portion of the transversus abdominis muscle; it has medial concavity and stretches from VIII-IX costal cartilage to pubic tu- bercle (9). The portion of aponeurosis situated between linea semilunaris and the lateral edge of rec- tus abdominis muscle is called Spigelian fascia. It is a week point, in particular in the zone crossing Douglas semicircular line, in which all aponeurosis of large ab- dominal muscles became anterior to the rectus muscle (in his lower 1 / 4 the rectus abdominis muscle is in di- rect contact with transversalis fascia) (10, 11). Other important factors in developing of this hernia are: 1) under the umbilicus the fibres of the transversus and internal oblique muscles run parallel giving rise to thin fingerings; 2) Spigelian fascia is crossed by inferior epigastric vessels, creating a spa- ce that may lead to the development of a sliding her- SUMMARY: Spigelian hernia: a case report and review of the lite- rature. A.M. ANGELICI, A.G. NASTI, N. PETRUCCIANI, G. LEONETTI, P. PALUMBO Spigelian hernia is a rare abdominal hernia that occurs through Spigelian aponeurosis. The Authors present a case of Spigelian hernia associated with nar- rowing of sigmoid colon and diverticular pathology. They also described historical background, surgical anatomy and etiopathogenesis of this hernia. By a remarkable revision of literature, they sum up epidemiology and clinical features of Spigelian hernia. Furthermore, they discuss dia- gnostic and therapeutic principles. RIASSUNTO: L’ernia di Spigelio: un caso clinico e revisione della letteratura. A.M. ANGELICI, A.G. NASTI, N. PETRUCCIANI, G. LEONETTI, P. PALUMBO L’ernia di Spigelio è una rara ernia addominale che fuoriesce at- traverso l’aponeuresi di Spigelio. Gli Autori presentano un caso clinico di ernia di Spigelio con im- pegno del colon, associato a patologia diverticolare. Descrivono la storia clinica, l’anatomia chirurgica e l’etiopatogenesi di tale patologia. L’ampia revisione della letteratura permette di puntualizzare l’epi- demiologia e le caratteristiche clinico-chirurgiche del’ernia. Gli Autori discutono inoltre le procedure diagnostiche e terapeutiche. KEY WORDS: Abdominal hernia - Spigelian hernia - Mesh repair. Ernia addominale - Ernia di Spigelio - Ernioplastica protesica. Università degli Studi “La Sapienza” di Roma Dipartimento di Scienze Chirurgiche “F. Durante” © Copyright 2006, CIC Edizioni Internazionali, Roma