EP-55 Subclinical Spigelian Hernia: Sailing with the Hidden Iceberg

Abstract Background Spigelian hernia quaintly designated as occult anatomical distortion is no less than a conjurer. Its diagnosis is extremely exigent and is complicated by a lack of physical findings and the surgeon's supposition. Therefore, a thorough physical examination along with high-level clinical suspicion remains crucial in diagnosing Spigelian hernia. Methods A retrospective data of all subclinical Spigelian hernia cases was scrutinized for clinical presentation, physical examination, radiological investigation, surgical treatment and outcome. Results Of 72 patients treated for subclinical Spigelian hernia, we found that females were affected twice more. The mean duration of symptoms was 10.69 months and was more on the right side (59.72%). The most common presenting symptom was intermittent, sharp, localised pain. On examination, tender point in linea semilunaris better elicited on leg raising test was found in 70.83% cases. Fascial rupture at the lateral border of rectus was found in all patients using real-time ultrasound. All patients underwent open surgical repair with 5 patients treated with anatomical repair and 67 patients with mesh preperitoneal hernioplasty. Recurrence was seen in only 1 patient who underwent anatomical repair and 13 patients developed postoperative complications, the most common being seroma (61.53%). Conclusion Spigelian hernias are rare and are believed to represent the tip of a prodigious yet unperceived iceberg. Their diagnosis requires a high index of clinical suspicion given the lack of prototypical signs and symptoms. Usually, the patient presents with abdominal pain syndrome and an astute clinician couple a proper history and physical examination with preoperative imaging to secure the diagnosis.