IS case 529: Small bowel herniation through the linea semilunaris

Alok Bhatt, MD

University of Rochester


Imaging Sciences URMC 2010
Publication Date: 2010-09-11

History

Patient is a 68-year-old male status post liver transplant presenting for evaluation of recurrence of hepatocellular carcinoma.

Findings

CT scan of the abdomen and pelvis demonstrated no evidence of focal liver lesions and patent vasculature. Evaluation of the soft tissues revealed herniation of small bowel through a defect in the left abdominal wall without evidence of obstruction.

Diagnosis

Small bowel herniation through the linea semilunaris

Discussion

Abdominal hernias are relatively common incidental findings seen on CT scans performed for other reasons. The most common sites of herniation are the inguinal canal and the femoral canal, the former seen more in males, while the latter seen more often in females. Less common hernias include umbilical and paraumbilical hernias, while even more rare are lumbar and obturator hernias, as well as Spigelian hernias as seen in this case.

A Spigelian hernia is defined as herniation through the linea semilunaris, formed from the aponeuroses of the anterior abdominal wall muscles along the lateral border of the rectus sheath. The bowel may be seen protruding between the external and internal oblique muscles or the internal oblique and transversus abdominis muscles.

References

  1. Upponi S, Bungay H. Imaging of abdominal wall hernias. Imaging 2006; 18:268-277. http://imaging.birjournals.org/cgi/content/abstract/18/4/268

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