General Surgery, University of Otago School of Medicine, Dunedin, New Zealand
General Surgery, Southland Hospital, Invercargill, New Zealand.
BMJ Case Rep. 2023 Aug 8;16(8):e251931. doi: 10.1136/bcr-2022-251931.
Spigelian hernia is a rare form of abdominal wall defect. Bilateral Spigelian hernias are even less common. Surgical repair of Spigelian hernias is recommended due to their high risk of incarceration and strangulation of abdominal contents. A variety of surgical approaches to repair these hernias have been described in the literature including the traditional open approach, laparoscopic transabdominal preperitoneal approach, laparoscopic intraperitoneal repair and laparoscopic totally extraperitoneal repair. Here, we present the case of an elderly female patient with rare bilateral Spigelian hernias, the right side containing incarcerated appendix and caecal pole. The left hernia was unrecognised on preoperative CT imaging. To our knowledge, very few cases have been reported in the literature. The patient underwent bilateral laparoscopic intraperitoneal mesh repair. All technical aspects of the treatment are discussed here, in the context of the current literature, including the surgical technique and the limitations of the CT diagnosis. We aim to summarise the background of these uncommon hernias, the limitations of preoperative investigations and the differences between the available operative approaches.
斯皮格尔疝是一种罕见的腹壁缺陷。双侧斯皮格尔疝则更为少见。由于斯皮格尔疝有较高的嵌顿和绞窄风险，建议进行手术修复。文献中已经描述了多种修复这些疝的手术方法，包括传统的开放手术、腹腔镜经腹腹膜前入路、腹腔镜腹腔内修补术和腹腔镜完全腹膜外修补术。在此，我们报告了一例老年女性双侧斯皮格尔疝的罕见病例，右侧疝内容物为嵌顿阑尾和盲肠尖。术前 CT 影像学未识别左侧疝。据我们所知，文献中仅报道过少数几例此类病例。患者接受了双侧腹腔镜腹腔内补片修补术。本文将结合当前文献，讨论该病例的所有治疗技术方面，包括手术技术和 CT 诊断的局限性。我们旨在总结这些罕见疝的背景、术前检查的局限性以及各种手术方法之间的差异。
