Spigelian Hernia

What is a Spigelian hernia?

A Spigelian (Spuh-gay-lee-an) hernia happens when a part of your intestines pushes through the tissue that separates your front abdominal muscles. The hernia makes a lump or bump in your lower belly.

Small Spigelian hernias may not cause painful symptoms. But large Spigelian hernias can cause serious medical issues. For example, a hernia may grow large enough to block your intestine. Or it may cut off the blood supply to your intestines (strangulated hernia). Healthcare providers may call this condition a lateral ventral hernia.

What are the symptoms of a Spigelian hernia?

One common symptom is a bulge or lump below and 2 to 3 inches to the side of your belly button. The bump or lump appears when you stand up and goes away when you sit or lie down. But a Spigelian hernia may not cause symptoms. Other symptoms are:

• A tender spot in your lower belly to the right or left side of your midline (linea alba)
• Severe belly pain that comes and goes and may happen while you poop or lift a heavy object

What causes a Spigelian hernia?

Spigelian hernias happen when specific abdominal muscles are weak. Those muscles are your transversus abdominis and internal oblique muscles. Those muscles may weaken as you age. This makes it easier for your large or small intestines to slip through the tissue that separates these muscles. Pregnancy may also weaken your abdominal muscles.

Medical issues that put pressure on your muscles may cause Spigelian hernias. Those conditions include:

• Chronic cough that can happen if you have chronic obstructive pulmonary disease (COPD)
• Chronic constipation
• Liver disease that leads to ascites (fluid buildup in your belly)
• Obesity

You may develop a Spigelian hernia if you’re hit in your lower belly. Healthcare providers may call this a traumatic Spigelian hernia.

What are the complications of a Spigelian hernia?

A Spigelian hernia may cause complications like:

• Bowel obstruction. In this case, part of your intestine is stuck in the opening so that undigested food can’t move through your intestine.
• Incarceration. This happens when the hernia traps part of your intestine or abdominal tissue.
• Strangulated hernia. If a loop of your intestine is caught in the hernia, it can cut off blood supply to your intestine. Without blood, your intestinal tissue starts dying (mesenteric ischemia).

These more serious issues may cause the following symptoms:

• Sharp belly pain that comes in waves
• A swelling sensation in your lower belly
• Severe constipation
• Nausea and vomiting
• Redness or darker skin in the area where there’s a lump

If you have these symptoms, call 911 or go to the emergency room.

How do healthcare providers diagnose Spigelian hernias?

A healthcare provider will do a physical examination. They’ll examine your lower belly. They may ask you to stand up or stretch while standing. They do that so they can check for a bulge in your lower belly that goes away when you sit down.

They may guide you through a Valsalva maneuver. This procedure causes internal pressure on your belly. That pressure may cause a bulge or lump. In a Valsalva maneuver, you take a breath, push out air with your mouth and nose closed and push down as if you’re pooping.

What tests will be done to diagnose Spigelian hernia?

Healthcare providers may do imaging tests like computed tomography (CT) scans or an abdominal ultrasound. They may do a laparoscopy to confirm a Spigelian hernia diagnosis.

How are Spigelian hernias treated?

Hernia repair surgery is the most common treatment. In Spigelian hernia repair surgery, a surgeon pushes your intestine back into place and repairs the hernia. Hernia repair surgery may be open, laparoscopic or robotic hernia repair surgery. Your surgeon will discuss your options.

Complications of hernia repair surgery

Hernia surgery, like all surgeries, may cause complications like:

• Hematomas (blood collecting under your skin)
• Injury to nearby tissue, organs or blood vessels
• Seromas (fluid collecting at the surgery site)
• Surgical site infection

What can I expect if I have a Spigelian hernia?

If you’re like most people, surgery to repair the hernia takes care of the issue. But you may need additional surgery if the hernia causes complications.

When should I see my healthcare provider?

It’s possible to develop another Spigelian hernia. You should contact your provider if you have symptoms like severe belly pain or a spot in your lower belly that’s painful to touch.