Case Report: Bilateral Spigelian Hernia With Meckel's diverticulum.

Abstract

Spigelian hernia is an uncommon form of ventral hernia, with an incidence ranging from 0.1% to 2%. This case report describes a 72-year-old female who presented with an obstructed right Spigelian hernia, a left Spigelian hernia, and an uncomplicated Meckel's diverticulum, along with the management approach. The patient had experienced intermittent tenderness in the right iliac fossa for the last two months, which had worsened to severe pain over the previous two days, accompanied by a palpable mass in the right lower quadrant. An urgent CT scan of the abdomen and pelvis revealed an obstructed right Spigelian hernia containing dilated proximal small bowel, and a left uncomplicated spigelian hernia. The patient experienced worsening abdominal pain and vomiting. Emergency laparotomy was performed, revealing a right Spigelian hernia with viable small bowel loops, a non-complicated Meckel's diverticulum located 20 cm from the ileocecal valve, and a small left Spigelian hernia. The right Spigelian hernia was repaired using intraperitoneal sublay mesh, while the left hernia was treated with primary repair. No bowel resection was performed at the site of the Meckel's diverticulum, as it was non-inflamed, to prevent contamination of the mesh with bowel flora. Bilateral Spigelian hernias accompanied by Meckel's diverticulum present a challenging clinical scenario. Although rare, this condition should be considered in the differential diagnosis of acute abdominal pain due to the potential for serious complications.