Rare clinical scenario and surgical approach for traumatic obstructed Spigelian hernia with penetrating scrotal injury: A case report.

INTRODUCTION AND IMPORTANCE

Traumatic Spigelian hernias, an unusual subtype of traumatic abdominal wall hernias (TAWH). This case highlights the individualized surgical management of Spigelian hernia depending on the presentation, history, and existence of concurrent intra-abdominal injuries. This case report, presented in line with the SCARE criteria, highlights a case of obstructed Spigelian hernia.

CASE PRESENTATION

We present a 37-year-old male patient involved in a free fall from a coconut tree while harvesting fruits. A sharp branch injured the scrotum before he landed on the ground. Then he started presenting with abdominal pain, failure to pass stool, abdominal distention, and later on vomiting. Abdominopelvic CT-scan showed ventral hernia concealed at the right lower quadrant of the abdomen with proximal intestinal dilatation. Exploratory laparotomy was done along with Spigelian hernia repair.

CLINICAL DISCUSSION

This case was atypical, lacking evidence-based guidelines on surgical treatment. Considering the emergency aspect of the case, we performed an exploratory laparotomy along with hernia repair. The scrotal wound was cleaned and left open. The postoperative follow-up was conclusive, as the patient recovered with the hernia tract having healed by fibrosis.

CONCLUSION

Spigelian hernia can be caused by trauma and may be difficult to diagnose at first glance. The attention should be paid to a thorough clinical examination and adequate workup. The surgical intervention may depend on intraoperative findings if done on an emergency basis.