Introduction:

Spigelian hernia represents 0.12 to 2% of the abdominal wall hernias; it is a defect in the aponeurosis of the transverse and oblique muscles, between the lateral border of the sheath of the rectus abdominis muscle and the semilunar line. It presents incarceration in 10.4% and strangulation in 6.7%. The herniated content is usually the small bowel and the omentum.

Case report:

An 80-year-old woman, with a history of eight months of progressive increase of volume in the right side flank, came to us with three days of intestinal obstruction and abdominal pain. A simple abdominal tomography was performed, finding an aponeurotic defect of 39 mm adjacent to the transverse and minor oblique muscles, with protrusion of the ascending colon that conditioned intestinal obstruction.

Objective:

To report a clinical case of Spiegel’s strangulated hernia, which presented as an acute abdomen secondary to intestinal obstruction. Its size and content were uncommon, and included terminal ileum, cecum, cecal appendix and ascending colon.

Conclusions:

Spiegel’s hernia is a rare defect; a challenge that usually leads to delayed diagnosis, which allows the development of clinical complications. The surgeon needs the knowledge of the pathology to keep a high degree of suspicion in patients with risk factors, in order to carry out a wide anamnesis and physical examination, relying on imaging studies. The definitive treatment is surgery.