PMC3350014_01
(a) Area of tenderness marked out on the abdominal wall prior to induction of anaesthesia. (b) Laparoscopic view of the Spigelian hernia.
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fig1
Prior to the induction of anaesthesia, the patient's abdomen was palpated and the area of maximal focal tenderness and the fullness was outlined with a marking pen (Figure 1(a)). Immediately upon entry, a loop of small bowel was seen herniating through a defect in the anterior abdominal wall and this coincided with the area that was marked over the skin (Figure 1(b)).
(a) The laparoscopic grasper tool demonstrating the slit like "Spigelian defect". (b) The hernia sac (arrow) after laparoscopic reduction of the incarcerated bowel.
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fig2
Laparoscopic reduction of bowel was done and a slit-like Spigelian defect about 3 cm by 2 cm was clearly seen (Figures 2(a) and 2(b)).
The external view of Spigelian hernia sac with (a) and without (b) transillumination with the laparoscope's light source.
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fig3
The sac was identified below the arcuate line which illuminated well with the light transmitted from the laparoscope (Figures 3(a) and 3(b)).