Muhammad Farhan Amin, Tabinda Sultan.
Strangulated Spigelian hernia.
Pak J Med Sci Jan ;20(3):251-2.

A 70-year-old female was admitted through emergency in November 2003, with severe pain in the swelling present in the right iliac fossa for the past three days. It was also associated with absolute constipation and vomiting for two days. Previously the swelling was reducible for 21h years and was not giving her any problems apart from mild discomfort. Past medical history included Hypertension, Diabetes Mellitus and two episodes of Myocardial Infarction during the past ten years but didn`t know the exact details as regards the timing. On examination she was vitally stable. Her diabetes was well controlled. Local examination revealed a lump in the right iliac fossa of approximately 7 x 7 cm, which was tense, extremely tender and without any cough impulse. X-Ray abdomen showed multiple fluid levels confirming the signs of bowel obstruction. History clinical examination together with the X-Ray finding of small bowel obstruction confirmed the diagnosis of strangulated Spigelian hernia. A laprotomy was performed and a gangrenous segment of ileum measuring 16 cm was resected. The defect in the transversus abdomin is aponeurosis and the internal oblique muscle was repaired with prolene. The patient recovered satisfactorily and was discharged on 9th post-operative day.

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