Spigelian Hernia

A Spigelian hernia is a rare type of abdominal wall hernia that develops along the side of the abdominal muscles. It occurs when abdominal tissue or intestine pushes through a weak area in the Spigelian fascia, a layer of tissue between muscles of the abdominal wall.

Spigelian hernias can be difficult to recognize because they do not always produce an obvious bulge. They also have a higher risk of becoming trapped or strangulated than some other abdominal wall hernias, which makes timely diagnosis and surgical evaluation important.

What Is a Spigelian Hernia?

The Spigelian fascia is a layer of tissue along the outer edge of the rectus abdominis, or “six-pack,” muscles.

A Spigelian hernia develops when a defect in this tissue allows fat, intestine, or other abdominal contents to protrude through the abdominal wall.

Most Spigelian hernias occur in the lower abdomen, often to the right or left of the belly button.

Unlike many other hernias, the protruding tissue may remain between layers of abdominal muscle rather than extending directly beneath the skin. This is why a Spigelian hernia may cause pain without a clearly visible lump.

What Are the Symptoms of a Spigelian Hernia?

Symptoms vary depending on the size and location of the hernia.

Possible signs include:

• Pain or tenderness on one side of the lower abdomen
• A lump or bulge near the side of the abdominal wall
• Pain that worsens with lifting, coughing, or straining
• Abdominal discomfort during physical activity
• A bulge that becomes more noticeable while standing
• Symptoms that improve when lying down

Some Spigelian hernias produce little or no visible swelling, which can make them harder to identify without imaging.

What Causes a Spigelian Hernia?

A Spigelian hernia develops when a weak area in the abdominal wall allows tissue to push through.

The weakness may develop over time or be associated with increased pressure inside the abdomen.

Factors that may contribute include:

• Age-related weakening of the abdominal wall
• Chronic coughing
• Chronic constipation and repeated straining
• Obesity
• Pregnancy
• Fluid buildup in the abdomen
• Previous abdominal injury or trauma

Repeated heavy lifting may also increase abdominal pressure, particularly when an area of the abdominal wall is already weakened.

Learn more about heavy lifting and hernia risk.

Why Can a Spigelian Hernia Be Hard to Detect?

Spigelian hernias do not always create the obvious bulge associated with other abdominal wall hernias.

The hernia may develop between layers of abdominal muscle, allowing the outer layer of muscle to cover the defect. A patient may therefore experience localized abdominal pain or tenderness even when no lump is easily visible.

Because symptoms can resemble other abdominal conditions, physical examination alone may not always identify a Spigelian hernia.

How Is a Spigelian Hernia Diagnosed?

Diagnosis usually begins with a physical examination.

A healthcare provider may examine the abdomen while you are standing and lying down and may ask you to cough or bear down to increase pressure inside the abdomen.

If the hernia cannot be clearly identified during the examination, imaging may be recommended.

Ultrasound

An abdominal ultrasound can help identify a defect or protruding tissue and may be performed while the patient is standing or straining.

CT Scan

A CT scan provides detailed images of the abdominal wall and can help identify Spigelian hernias that are difficult to detect during a physical examination.

CT imaging may also help determine what tissue is contained within the hernia and whether complications are present.

Does a Spigelian Hernia Need Surgery?

Spigelian hernias are generally treated with surgical repair because of their increased risk of incarceration and strangulation.

Unlike some small abdominal wall hernias that may sometimes be monitored, watchful waiting is generally not recommended once a Spigelian hernia has been diagnosed.

The timing and type of surgery depend on factors such as:

• Size and location of the hernia
• Symptoms
• Whether tissue is trapped
• Previous abdominal surgery
• Overall health
• Whether complications are suspected

A hernia that has become incarcerated, obstructed, or strangulated may require urgent treatment.

How Is a Spigelian Hernia Repaired?

Spigelian hernia repair can be performed using open, laparoscopic, or robotic-assisted surgical techniques.

Open Spigelian Hernia Repair

During open repair, the surgeon makes an incision near the hernia, returns the protruding tissue to the abdomen, and repairs the defect in the abdominal wall.

Depending on the characteristics of the hernia, sutures or surgical mesh may be used to reinforce the repair.

Laparoscopic or Robotic Spigelian Hernia Repair

Some Spigelian hernias can be repaired using minimally invasive laparoscopic or robotic-assisted techniques.

These approaches use small incisions and specialized instruments to access the abdominal wall and repair the defect.

The appropriate approach depends on the size and location of the hernia, previous surgeries, whether complications are present, and other individual factors.

Learn more about laparoscopic hernia surgery.

What Happens if a Spigelian Hernia Is Left Untreated?

A Spigelian hernia can become trapped because the opening through which the tissue passes may be relatively narrow.

Potential complications include:

• Incarceration: Tissue becomes trapped within the hernia and cannot return to the abdomen.
• Bowel obstruction: Part of the intestine becomes trapped and blocks the normal movement of intestinal contents.
• Strangulation: The blood supply to trapped tissue becomes compromised.

Strangulation can damage intestinal tissue and requires emergency medical treatment.

Learn more about incarcerated hernias.

When Is a Spigelian Hernia an Emergency?

Seek immediate medical attention if a known or suspected Spigelian hernia is accompanied by:

• Sudden or severe abdominal pain
• A painful or tender bulge
• Persistent nausea or vomiting
• Severe constipation or inability to pass stool or gas
• Redness or darkening of the skin over a bulge
• Rapidly worsening symptoms

These symptoms may indicate bowel obstruction, incarceration, or strangulation and require prompt medical evaluation.

What Is Recovery Like After Spigelian Hernia Surgery?

Recovery depends on the size and complexity of the hernia, the surgical approach, whether emergency treatment was required, and the patient's overall health.

After surgery, patients may receive instructions regarding:

• Walking and light activity
• Incision care
• Pain management
• Lifting restrictions
• Returning to work
• Resuming exercise
• Follow-up appointments

Your surgeon will provide individualized guidance about when it is safe to return to normal activities.

Spigelian Hernia Surgery in the East Bay

Hernia Innovations provides evaluation and surgical treatment for Spigelian and other abdominal wall hernias throughout the East Bay.

Our board-certified surgeons evaluate the location and complexity of the hernia, symptoms, imaging findings, medical history, and risk of complications to determine the appropriate surgical approach.

When surgery is recommended, treatment may include open, laparoscopic, or robotic-assisted hernia repair based on the patient's individual condition.

Call (925) 940-1025 or request an appointment online.

Frequently Asked Questions About Spigelian Hernias

Is a Spigelian hernia dangerous?

A Spigelian hernia can become serious because tissue can become trapped within its relatively narrow opening. This increases the risk of incarceration, bowel obstruction, and strangulation.

Where is a Spigelian hernia located?

A Spigelian hernia usually develops along the side of the abdominal wall, often in the lower abdomen to the right or left of the belly button.

Can you have a Spigelian hernia without a bulge?

Yes. Some Spigelian hernias develop between layers of abdominal muscle and may cause pain or tenderness without an obvious visible bulge.

Can a Spigelian hernia go away on its own?

No. A Spigelian hernia does not repair itself. Surgical repair is generally recommended because of the risk of tissue becoming trapped or strangulated.

How is a Spigelian hernia diagnosed?

Diagnosis may include a physical examination and imaging. Ultrasound or CT imaging can help identify Spigelian hernias that are difficult to detect during an examination.