右季肋部に発生した大きなSpigelヘルニアの1例

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  • A CASE OF LARGE SPIGELIAN HERNIA IN THE RIGHT SUBCOSTAL REGION

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Most of Spigelian hernias occur in the lower abdomen. There is no domestic report of the disease arising from upper reaches of the semilumar line. In the foreign literture, the incidence of “upper” Spigelian hernia is only 3%, especially the case in the subcostal region has been reported only once. We report a case of Spigelian hernia originating from the right subcostal region. The patient was a 69-year-old woman who had no previous abdominal injury. There was bulging arised from the right upper quadrant, when she had severe cough due to pneumonia. It was observed at standing position, and disappered in the left lateral position. A wide-ranging defect of the abdominal muscle was palpated. On abdominal CT scan, there were defects of internal oblique muscle and transversus abdominis muscle at the lateral side of rectus muscle in the right upper quadrant. And intestinal gas shadow was observed just under the external oblique muscle. She was diagnosed as having a ventral hernia. Uppon laparotomy, there was a hernia sac (12×5cm) under the external oblique muscle, and the size of hernia orifice was 10×4cm. No hernia content was noted. The orifice with internal oblique muscle and transversus abdominis muscle was closed with interrupted suture, followed by repair using polypropylene mesh.

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