Spigelian hernia occurs through
Ans) b (Aponeurotic ....) Ref Sabiston 18th ed pg 1214Spigelian herniaOccurs through the spigelian fascia which is composed of the aponeurotic layer between the rectus muscle medially and the semilunar line laterally. Small -1 -2cm in diameter.Develop during the fourth to seventh decades of life.Localised pain in the area without a bulge (beneath the intact external oblique aponeurosis.)USG or CT abdomen confirms diagnosis.Risk for incarceration due to its relatively narrow neck.Obturator herniaWeakening of obturator membrane covering obturator canal. Obturator canal is formed by union of the pubic bone and ischium.Causes intestinal incarceration & strangulation.Howship-Romberg sign - compression of the obturator nerve which causes pain in the medial aspect of thigh.One half of patients present with complete or partial bowel obstruction.CT abdomen confirms diagnosis.Lumbar herniaEither congenital or acquired & occur in the lumbar region of the posterior abdominal wall. Hernias through superior lumbar triangle are more common.Superior lumbar triangle (Grynfeltt's triangle)- bounded by the 12,h rib, paraspinal, and internal oblique muscle.Inferior lumbar triangle (Petit's triangle)- bounded by the iliac crest, latissimus dorsi muscle, & external oblique muscle.Lumbar hernias are not prone to incarceration.Some named hernias1) Richter's hernia -Hernia in which the sac contains only a portion of the circumference of the intestine (usually small intestine). It usually complicate femoral & rarely Obturator hernia.2) Laugier's femoral hernia -This is a hernia through a gap in the lacunar (Gimbernat's) ligament. The hernia commonly strangulates.3) Narath's femoral hernia -Occurs only in patients with congenital dislocation of the hip & is due to lateral displacement of psoas muscle. Hernia is hidden behind the femoral vessels4) Cloquet's hernia -Sac lies under the fascia covering the pectineus muscle. Sac may co exist with the usual type femoral hernia sac5) Spigelian hernia -Hernia occurs through the linea semilunaris at the level of arcuate line i.e, a few centimeters above the inguinal ligament. Victims are above 50 years of age.6) Lumbar hernia -Occurs through Petit's triangle bounded below by crest of the ilium, laterally by the external oblique & medially by latissimus dorsi7) Hernia-en-glissade or Sliding hernia -A piece of extraperitoneal bowel, usually the caecum on the right side or the pelvic colon on the left side or the urinary bladder on either sides slides down out side the hernial sac forming a part of its wall being covered by the peritoneum on the hernial aspect only. Since left side is much more common than right side Sigmoid is the most common content of sliding hernia8) Littre'shernia -Hernia which contains Meckel's diverticulum9) Maydl's hernia or Hernia-en-w or Retrograde strangulation -Two loops of bowels remains in the sac & the connecting loop remains within the abdomen and be- comes strangulated.10) Gibbon's hernia - it is hernia with hydrocele11) Berger's hernia - Hernia in pouch of Douglas
Superior lumbar triangle
Aponeurotic layer between rectus muscle and semilunar line
Membrane covering canal between pubic bone & ischium
Inferior lumbar triangle.
Hernia