INTRODUCTION: Abdominal wall hernias (AWH) of unusual presentation include Spigelian hernia (SH), obturator hernia (OH), lumbar hernia (LH) and intraparietal hernia (IPH), among others. Their diagnosis requires of a high index of suspicion and frequent use of imaging studies. PATIENTS AND METHOD: We performed a retrospective review of the AWH treated between 1990 and 2004. Of a total of 2,973 hernias, 16 (0.53%) were in infrequent locations: 12 SH (0.4%), 2 OH (0.06%), 1 LH (0.03%), 1 IPH (0.03%). All the SH showed a palpable mass. They were more frequent in men (7 men and 5 women). Emergency surgery was performed in 25%. When imaging studies were carried out, ultrasonography confirmed only 20% while computed tomography (CT) confirmed 100%. In all patients who underwent surgery for HS, the diagnosis was made preoperatively. Seven small defects were repaired by simple closure (with 1 recurrence); 5 were repaired by a polypropylene mesh cone through the anterior extraperitoneal route. Fifty percent were associated with other AWH. Two OH presented with intestinal obstruction and preoperative diagnosis was made by CT. One IPH also presented with intestinal obstruction and preoperative diagnosis was made by ultrasonography; in 2 patients intestinal resections were performed with mesh repair. The LH had a preoperative diagnosis of lipoma by CT. CONCLUSIONS: AWH of unusual presentation can present as acute complications. Treatment is indicated after diagnosis. Surgical repair can be performed by primary closure or mesh repair through the open or laparoscopic route. The most suitable repair technique for each type of hernia should be selected.
INTRODUCTION: Abdominal wall hernias (AWH) of unusual presentation include Spigelian hernia (SH), obturator hernia (OH), lumbar hernia (LH) and intraparietal hernia (IPH), among others. Their diagnosis requires of a high index of suspicion and frequent use of imaging studies. PATIENTS AND METHOD: We performed a retrospective review of the AWH treated between 1990 and 2004. Of a total of 2,973 hernias, 16 (0.53%) were in infrequent locations: 12 SH (0.4%), 2 OH (0.06%), 1 LH (0.03%), 1 IPH (0.03%). All the SH showed a palpable mass. They were more frequent in men (7 men and 5 women). Emergency surgery was performed in 25%. When imaging studies were carried out, ultrasonography confirmed only 20% while computed tomography (CT) confirmed 100%. In all patients who underwent surgery for HS, the diagnosis was made preoperatively. Seven small defects were repaired by simple closure (with 1 recurrence); 5 were repaired by a polypropylene mesh cone through the anterior extraperitoneal route. Fifty percent were associated with other AWH. Two OH presented with intestinal obstruction and preoperative diagnosis was made by CT. One IPH also presented with intestinal obstruction and preoperative diagnosis was made by ultrasonography; in 2 patients intestinal resections were performed with mesh repair. The LH had a preoperative diagnosis of lipoma by CT. CONCLUSIONS: AWH of unusual presentation can present as acute complications. Treatment is indicated after diagnosis. Surgical repair can be performed by primary closure or mesh repair through the open or laparoscopic route. The most suitable repair technique for each type of hernia should be selected.