# A Case Report on a Hybrid Approach to Managing Acute Large Bowel Obstruction Secondary to Spigelian Hernia

## TL;DR

This case report describes a rare instance of a Spigelian hernia causing a bowel obstruction in an elderly patient and emphasizes the importance of timely surgical intervention.

## Contribution

The novelty lies in presenting a real-world case that underscores the diagnostic and management challenges of Spigelian hernias.

## Key findings

- The patient developed a large bowel obstruction secondary to an incidental Spigelian hernia.
- Emergency surgery was required after initial plans for elective management were altered due to complications.
- The patient recovered well after emergency surgical intervention.

## Abstract

Spigelian hernias are an uncommon type of primary ventral hernia and are defined as a defect in the Spigelian aponeurosis (fascia). Herein, we present an uncommon case of Spigelian hernia to highlight the potential complications of these hernias and the need for surgical management. This is a case report of an 86-year-old gentleman presenting post-fall with an acute rib fracture and an incidental Spigelian hernia seen on a CT trauma pan scan. The Spigelian hernia surgical treatment was planned for elective management due to the anesthetic risks associated with an elderly patient and acute rib fractures. Ultimately, the patient developed a large bowel obstruction secondary to the Spigelian hernia and required emergency operative management to relieve the obstruction. The patient had an uncomplicated recovery following his emergency surgery.

This case report highlights the importance of assessing anesthetic risks versus surgical risks when it comes to surgical planning. Clinicians should recognize occult hernias and continue ongoing clinical reviews with a high index of suspicion, as symptoms of Spigelian hernia obstruction might be non-specific.