PMC6815558_01
Abdominal ultrasound scan showing the over-distended bowel in the left anterior abdominal wall.
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Investigation results show the following data: full blood count: total white cell count 13.9 g/L, hemoglobin 11.9 g/dL, and platelets 563 g/L; serum electrolytes: chloride 99.9 mmol/L, sodium 134.9 mmol/L, and potassium 5.40 mmol/L generally normal; and abdominal ultrasound scan: bowel loops were distended (Figure 2) with contents showing back and forth peristaltic motion.
Abdominal X-ray anteroposterior showing air fluid level with a protrusion in the left anterior abdominal wall.
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An erect abdominal X-ray revealed uneven bowel gas distribution mainly in the upper abdomen with dilated bowel loops and significant air fluid levels (Figure 3).
The defect of Spigelian hernia with contents.
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Intraoperatively, using a Rutherford-Morrison incision in the left anterior abdominal region, the abdomen was opened in layers; a large defect was found (6 x 5 cm) at the Spigelian aponeurosis (Figure 4), with a huge, thick, inflamed sac protruding; the sac was opened; and an inflamed jejunum was found, obstructed with adhesions (Figure 5).
Sac of Spigelian hernia and the inflamed jejunum in a perioperative period.
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fig5
Intraoperatively, using a Rutherford-Morrison incision in the left anterior abdominal region, the abdomen was opened in layers; a large defect was found (6 x 5 cm) at the Spigelian aponeurosis (Figure 4), with a huge, thick, inflamed sac protruding; the sac was opened; and an inflamed jejunum was found, obstructed with adhesions (Figure 5).
Operating wound showing the mesh being positioned and being sutured under the layers in the left anterior abdominal wall.
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The Spigelian hernia was repaired with a mesh under layers (of the rectus sheath), fixing it with Nylon 0, from the lower part of the inguinal ligament and up to the sheath of the muscles; the mesh was covered with the sheath of the rectus and transversus muscle (Figure 6).
The wound on the anterior abdominal wall after being sutured.
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The mesh was subcutaneously apposed with Vicryl 2/0, and the skin was closed with Vicryl 2/0 (Figure 7).