怒責を契機に生じたと思われるＳｐｉｇｅｌヘルニアの１例

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  • A Case of Spigelian Hernia Brought About by Straining

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Spigelian hernia is rare in all abdominal hernia. We report a case of Spigelian hernia which was broughtabout by straining. A 32-year-old man suffered a severe low back pain when he strained trying to lift a carwhich had gone over the edge of a curb and into the gutter. The pain was soon localized in the right lowerquadrant and a fist-sized bulge was present at the same place. A bulge was recognized when the patient wassitting erect, but was reduced in the supine position. In abdominal CT, no abnormalities could be seen inthe supine position, however in the prone position, intra-abdominal content was seen to protrude from theabdominal wall at the lateral side of the rectus muscle in the right lower quadrant. We operated under thediagnosis of Spigelian hernia, and found a laceration approximately 2cm long on the aponeurosis of theexternal oblique muscle. After division of the aponeurosis the hernia sac was seen, and a defect 3×3cmin size in the aponeurosis of the internal oblique muscle and transverse abdominal muscle was also revealed.The orifice was closed with an interrupted suture, followed by repair using polypropylene mesh. In this case, we considered that high intraabdominal pressure on straining might have caused the hernia.

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