How does a hernia of the semilunar or spigelian line of the abdomen manifest itself
A hernia of the Spigelian (lunate) line of the abdomen is a rare form of pathological protrusion of the abdominal organs in the area between the transverse abdominal muscle and the lunate line, where there is a defect in the aponeurosis. Distinguish between true and false formations. In the first case, a hernia of the Spigelian line of the abdomen contains a hernial sac, a hilus, and contents consisting of an omentum, parts of the intestine, and Meckel's diverticulum.
Such a protrusion is more often located along the edge from the rectus muscles of the abdominal wall at the level of the semilunar line. The cause of this defect is congenital factors and high intra-abdominal pressure. This atypical form of the disease requires surgical treatment, because a spigelian hernia without removal leads to complications such as strangulation and necrosis of organs.
What is a hernia of the Spigelian line
The protrusion in the region of the Spigelian line externally is a round or oval formation below the navel in the direction from the umbilical ring to the ilium.
A hernia of the semilunar line can contain the following organs:
- one or more loops of the small intestine;
- caecum;
- stuffing box;
- colon;
- gallbladder.
This disease is equally often diagnosed among men and women, but this localization of the protrusion is only 1% of all clinical cases.
Many experts note that a semilunar hernia occurs much more often, but it proceeds hidden for a long time, and it becomes known when the patient is on the operating table with suspected appendicitis or a protrusion of another localization.
The pathologist Kolyubakin S. L. noted that the main factor in the formation of such a hernia is weakness in the region of the lateral edge of the muscles of the abdominal wall. The doctor's practice has shown that the muscles of the semilunar line have anatomical gaps up to 15 mm in size, and they were detected in 40% of the subjects. In this case, the defect can be of three types: subcutaneous, properitoneal and interstitial . Later Larin V.I. conducted similar studies and concluded that most of the cracks are located in the place of the semicircular line, where the hernia is most often formed.
Etiology of the disease
Muscle weakness is the main cause of abdominal hernia, but it is combined with many other factors that provoke the divergence of the aponeurosis and the exit of the abdominal organs through the enlarged anatomical holes.
What can provoke the appearance of a hernia of the Spigelian line:
- recurring increase in intra-abdominal pressure, which occurs with coughing, lifting weights, bloating and constipation;
- traumatic injury to the abdominal muscles, surgery, open wound;
- transferred difficult childbirth, polyhydramnios and multiple pregnancy;
- obesity and a sedentary lifestyle, thinning of the muscle layer and its replacement with a fatty layer.
The risk group includes overweight people, as well as those whose activities are associated with hard physical work. Athletes, beginners in sports who do not have proper training often suffer from hernias of different localization.
Women usually experience a hernia during gestation, when the muscles are stretched and intra-abdominal pressure rises. A second pregnancy will also be a risk factor. In children, such localization of a hernia is extremely rare.
Clinical picture
A hernia of the semilunar line has similar manifestations with pathologies of other localization. Outwardly, a protrusion is determined below the navel, which periodically disappears at rest and in the supine position. Pathology can be bilateral, then the formation is visible in the region of the semilunar and semicircular lines.
A patient with a hernia of the Spigelian line has the following complaints:
- periodic dull pain in the area of protrusion;
- nausea, single vomiting;
- dyspeptic disorders, including diarrhea and constipation;
- stable feeling of discomfort in the lower abdomen.
An uncomplicated hernia worries only with moderate periodic pain, while the patient can do his usual activities, the quality of life does not suffer from this. But if you do not take any measures, the hernia increases in size, the muscles stretch even more.
At any time, a large volume of the organ can enter the hernial sac, which leads to infringement. Squeezing the contents is accompanied by ischemia, tissue nutrition is disrupted, compression leads to the death of individual structures. Infringement is dangerous because inflammation, necrosis of organs occurs, and it will no longer be possible to save damaged tissues. The operation in this case will be aimed at removing dead elements to save part of the organ.
After an external examination, the surgeon may prescribe studies such as ultrasound or MRI in order to assess the condition in detail and select the removal technique.
Differential diagnosis is carried out with appendicitis, benign tumor, cancer, metastases, pancreatitis. Difficulties in diagnosing are possible with a small size of the hernia, when it is located interstitially and there is a large fat layer. These factors can cause complications when the patient does not seek help in a timely manner with mild symptoms.
How is the treatment carried out
The protrusion of the Spigelian line of the abdominal wall is treated only surgically. The operation is performed by an open method with the tension of one's own tissues, but when there are no complications, the option of tension-free hernioplasty and laparoscopic surgery is considered.
The laparoscopic technique is more often prescribed for women, due to the absence of wide scars, but the patient does not always have the opportunity to choose the operating technique. Herniotomy is performed under local anesthesia, less often general anesthesia is indicated.
Access to the hernial contents can be created through transverse, oblique or pararectal incisions. The most sparing option would be oblique pararectal access, which will protect you from accidental damage to nerve fibers as much as possible. During any operation, the surgeon removes the hernial sac, returns the organs to their place and sutures the muscles with tension on the patient's tissues or suturing the mesh.
Rehabilitation
Principles of recovery after removal of a hernia of the Spigelian line:
- anesthesia - taking analgesics and NSAIDs;
- prevention of scar suppuration - a course of antibacterial drugs;
- dieting - eating light food, avoiding constipation;
- wearing a postoperative bandage;
- visiting a doctor for a routine check-up;
- exclusion of alcohol;
- ban on physical activity.
A few weeks after the operation, the doctor will recommend doing therapeutic exercises, swimming, and doing exercises to strengthen the abdominal muscles. To prevent re-hernia, it is important to eliminate risk factors in the form of excess weight, muscle weakness, and gastrointestinal diseases.
A hernia of the lunate or Spigelian line has a high risk of complications and is difficult to diagnose. If swelling is found in the abdomen, you should not hesitate to contact a doctor, because the operation should be carried out as quickly as possible with appropriate preparation.
