Simultaneous Management of May-Thurner Syndrome and Spigelian Hernia: A Case Report.

Abstract

BACKGROUND A Spigelian hernia is a ventral hernia that occurs through the Spigelian fascia, formed by the aponeuroses of the transversus abdominis and internal oblique muscles; it may contain peritoneum or abdominal contents. This report describes an older woman who exhibited left leg swelling and intermittent right lower abdominal pain due to compression and thrombosis of the left common iliac vein by an overriding right common iliac artery (May-Thurner syndrome), in conjunction with a right-sided Spigelian hernia. CASE REPORT A 63-year-old woman presented with left leg swelling and intermittent right lower abdominal pain. She initially developed left lower extremity edema, for which percutaneous intervention was performed to treat venous obstruction. During the same admission, she experienced bowel obstruction and right lower quadrant abdominal pain, leading to a diagnosis of incarcerated Spigelian hernia. Computed tomography revealed a non-occlusive thrombus of the left iliac vein consistent with May-Thurner syndrome, as well as a right-sided Spigelian hernia containing obstructed, dilated small bowel loops. The patient underwent endovascular thrombectomy and stenting of the left iliac vein, followed by laparoscopic mesh repair of the Spigelian hernia. Both procedures were completed without complications. CONCLUSIONS This case illustrates the simultaneous occurrence of left common iliac deep vein thrombosis secondary to May-Thurner syndrome and a Spigelian hernia associated with obstructive symptoms. Successful diagnosis and management of these rare conditions were achieved through interdisciplinary collaboration, advanced imaging, and minimally invasive intervention.