Richter-Type Spigelian Hernia Presenting With Small Bowel Obstruction: A Case Report.

Abstract

Spigelian hernia is a rare ventral abdominal wall hernia occurring along the semilunar line (Spigelian fascia), accounting for approximately 1%-2% of all hernias. It often presents with non-specific abdominal pain and carries a high risk of bowel incarceration and strangulation. Because the hernia sac lies beneath muscle, a palpable mass may be absent, making diagnosis challenging without imaging. We report a case of a previously healthy middle-aged man who awoke with sharp right lower quadrant pain. Physical exam revealed localized tenderness and a 2×4 cm mass that was deep, small, and obscured by overlying muscle in the right iliac fossa with audible bowel sounds. Imaging confirmed a right Spigelian hernia containing ileal loops with features of small bowel obstruction. An emergency combined laparoscopic and open hernia repair was performed; the incarcerated bowel was viable and reduced, and a mesh was placed to reinforce the defect. The patient's postoperative course was uneventful with a gradual return of bowel function and no complications. This case underscores the importance of high clinical suspicion and prompt imaging in diagnosing Spigelian hernias. Early surgical intervention in such cases can prevent strangulation and leads to favorable outcomes.