RARE CASE OF GIANT SPIGELIAN HERNIA WITH LOSS OF DOMAIN

Abstract

Spigelian hernia is a rare type of ventral abdominal wall hernia that develops through a defect in the Spigelian fascia along the semilunar line and accounts for less than 2% of all abdominal wall hernias. Owing to its interparietal location and frequently vague clinical presentation, diagnosis is often delayed until the hernia enlarges or complications develop. Giant Spigelian hernias associated with loss of domain are exceptionally uncommon and present significant reconstructive challenges because a considerable proportion of the abdominal viscera remain outside the abdominal cavity, increasing the risk of respiratory compromise and abdominal compartment syndrome following repair. We report the case of a 68-year-old male who presented with a progressively enlarging swelling over the right lower anterior abdominal wall of several years duration. Contrast-enhanced computed tomography demonstrated a large right sided Spigelian hernia with an abdominal wall defect measuring 8 × 8.1 cm containing bowel loops without evidence of obstruction. The patient also had an incidental left inguinal hernia containing omentum, bilateral renal calculi, and chronic right hydrocele. Considering the large defect and loss of abdominal domain, surgical repair was performed using a combined anterior and posterior component separation technique with prosthetic mesh reinforcement, achieving tension free closure of the abdominal wall. The postoperative recovery was uneventful, and the patient was discharged in stable condition without early complications.