A hernia of the Spigelian line of the abdomen is a protrusion of the abdominal organs through a defect in the lunar line in the region of the anterior lateral wall of the abdomen. Initially, a small one-sided formation appears, characterized by a soft consistency. As they grow, discomfort appears along with constipation or loose stools, pain, aggravated by coughing and straining. As part of the diagnosis, a thorough physical examination is carried out, an anamnesis is collected, CT data are studied. Surgical treatment is required. An open intervention is carried out with the strengthening of the area of the lunar line by fascia or an artificial prosthesis. With uncomplicated hernia of medium size, laparoscopic hernioplasty is performed.
Description
A hernia of the Spigelian line of the abdomen is considered a surgical pathology, which manifests itself as a bulging of the contents of the abdominal cavity through a weak spot in the muscle aponeurotic layer. A hernial protrusion is formed downward from the umbilical ring towards the anterior upper part of the ilium in the area of transition of the transverse and internal oblique muscles into aponeurosis.
Sometimes there is a hernia of the Spigelian line of the abdomen on the left or on the right.
The disease got its name in honor of the Belgian anatomist, who was first able to describe such a condition. In surgery, a hernia of the Spigelian line of the abdomen is rare, it makes up about one percent of all cases of abdominal formations. It occurs mainly among the elderly (over sixty years old), more often fixed in women. Many patients are looking for a photo of a hernia of the Spigelian line of the abdomen on the Web.
Pathogenesis
The spigel line is located in the area of transition of the muscles of the anterior abdominal walls to the aponeurosis, it is adjacent to the vagina of the rectus tissue. In the tendon wide plate of the transverse muscle there are slit-like openings, in which the diameter is fifteen millimeters, epigastric vessels exit through them. This site serves as the site of formation of hernias of the Spigel line.
Such pathological protrusions consist of a hernia gate, a bag and contents. Under the gate means a weak area in the muscle layer of the slit-like or oval-shaped wall through which the bulge occurs. The parietal peritoneum plays the role of a bag, in which there may be different parts of the intestine (thin, colon, omentum), gall bladder, and other abdominal elements.
Against the background of a deterioration in the extensibility of the abdominal muscles and trophism, as well as an increase in pressure under the influence of various factors (physical activity, childbirth), the process of stratification of the aponeurosis occurs in combination with an increase in the slit-like openings and the formation of hernial gates. Through the defect in the tendon fibers, subserous tissue acts, a preperitoneal lipoma is formed. Further, the adjacent organs of the abdominal region penetrate into the hernial gate, forming the contents of the bag. Next, let's talk about the main causes of the described pathology in people.
Causes
In the development of a hernia of the spigel line of the abdomen, an important role is played by a decrease in the elasticity of the muscular skeleton along with a weakening of the aponeurosis in the spigel region. Factors that lead to the occurrence of such a pathology can be divided into the following two groups:
- Predisposing causes. The conditions that create the conditions for the formation of a hernia include congenital defects of the spigel site along with traumatic injuries, a decrease in muscle distensibility due to aging of the body.
- Generating factors cause a prolonged increase in intra-abdominal pressure in combination with weakening of the abdominal muscles. These include excessive physical activity along with weightlifting, chronic constipation, frequent coughing as a result of bronchitis and other pulmonary diseases, as well as ascites and overweight. A multiple pregnancy with severe prolonged childbirth contributes to the weakening of the tissues of this zone, to sharp pressure surges during attempts.
Classification
Like other types, a hernia of the lunar line of the abdomen can be small and large, unilateral and bilateral, uncomplicated and restrained. Depending on the localization, the following three types of hernia of the Spigel line can be distinguished:
- The subcutaneous appearance, which is characterized by a hernial protrusion located under the skin, passing through the tendon plates of the external oblique muscles.
- The interstitial type involves a hernial bag passing through the transverse muscle.
- Preperitoneal view. In this case, the hernial sac prolapses into the fiber, which is located between the peritoneum and the transverse fascia.
Symptoms of a hernia of the Spigelian line of the abdomen
The clinical picture of this pathology can be different, directly depends on the size and type of hernial bulging. The course of the disease is conditionally divided into three stages. The initial stage of the formation of pathological protrusion has almost no manifestations. At this time, concomitant signs may be noted in the form of gallbladder dysfunction, changes in intestinal motility. Then there is a swelling of the abdominal walls, often one-sided.
A prolonged course of the disease leads to discomfort in the abdomen, pain on the right or left, diarrhea or constipation. The volumetric formation in case of palpation is soft, elastic, with a small size it is adjusted independently. As the hernia grows, a painful sensation increases, which intensifies with straining or coughing.
Complications
One of the most common complications (sixty percent of cases) is a hernia infringement, which requires the urgent help of a surgeon. The frequent occurrence of such a condition is directly related to the anatomical narrowness of the hernial collar and the small plasticity of the edges. In the absence of therapy, ischemia develops in combination with necrosis of the strangulated intestinal lobe.
A prolonged presence of the intestinal loop in the hernial sac leads to coprostasis. Long stool stools cause obstruction of the organ. In case of infection of the hernial bag or its contents, inflammatory processes occur with suppuration. Lack of timely intervention can lead to the development of sepsis and peritonitis.
Diagnostics
Difficulties in diagnosing hernias of the lunar line are largely due to the long absence of symptoms of the disease, insufficient experience of abdominal surgeons due to the low prevalence of pathology.
To confirm such a diagnosis, it is necessary to undergo the following examinations:
- Survey by a surgeon. The specialist conducts standard studies, prescribing additional diagnostic techniques. A major role is played by the study of the patient’s life history (his lifestyle, sports, workplace).
- Ultrasound examination of the abdominal region. Using the ultrasound method, you can evaluate the work of organs and detect hernial bags with contents.
- Performing computed tomography of the abdominal organs. Conducted with contrasting in order to better visualize the protrusion. Allows you to determine the exact location and size of the hernia, as well as the composition of the bag.
In the absence of complications, laboratory diagnosis is uninformative. The disease differentiates with various tumors of the abdomen. In this situation, instrumental research methods help to make the correct diagnosis. The swelling of the spigelic region is differentiated with hernias of other locations (white line of the abdomen, inguinal protrusion, and so on).
What is the operation for a hernia of the Spigelian line of the abdomen?
Surgical treatment
Given the risks of possible complications, the elimination of pathological protrusion is carried out operatively. In surgery, there are only three methods of hernia section: the traditional type, performing hernioplasty with a mesh prosthesis and laparoscopic technique. An open operation is performed using pararectal oblique access, which is anatomically beneficial and helps protect the nerve trunk and vessels of the anterior wall from damage.
When using the traditional operation for hernia of the Spigel line, the fascial layers are strengthened with the help of the abdominal muscles. In obese and elderly patients, hernia repair is performed to prevent recurrence of the disease, with hemming of the intact synthetic material (i.e., mesh).
The most modern and safe method due to low invasiveness and shorter rehabilitation time is laparoscopic removal of a hernia of the Spigelian line of the abdomen. A photo cannot reflect the whole picture.
Recovery
The principles of recovery after surgical treatment are usually as follows:
- Anesthesia in the form of analgesics and non-steroidal drugs.
- Perform prophylaxis of suppuration of the scar. For this, a course of antibacterial drugs is usually carried out.
- Compliance with the patient's diet in the form of eating light food. It is very important to eliminate constipation.
- Mandatory wearing a postoperative bandage.
- A regular visit to the doctor for a scheduled examination.
- Complete exclusion of alcohol.
- The introduction of a ban on physical activity.
A few weeks after the operation, doctors recommend doing gymnastics, and, in addition, swimming, performing all kinds of exercises to strengthen the press. To prevent re-education, it is important to eliminate risk factors in the form of excess weight, muscle weakness, and digestive system diseases.
Conclusion
It is worth noting that this type of hernia has high risks of complications and is difficult to diagnose. In the event of a swelling in the abdomen, there is no need to hesitate to see a doctor, because the operation in this situation should be carried out as soon as possible with appropriate preparation.