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Arch Surg. 2007;142(8):800.

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Answer: Combined Spigelian and Richter Hernias

Figure 1 shows an anterior abdominal wall defect at the junction of the semilunar line and lateral border of the left rectus sheath with a loop of incarcerated bowel. A laparoscopic repair was planned. Insufflation of the abdomen caused spontaneous reduction of the combined spigelian and Richter hernias. The bowel was examined and the wall did not appear ischemic. The abdominal wall defect was easily appreciated (Figure 2). A large peritoneal flap was created, including the hernia sac, to expose the musculoaponeurotic walls of the defect. A large piece of polypropylene mesh was used to cover the defect and create a tension-free repair. The peritoneum was then rolled over the mesh and tacked in place to avoid direct contact between the mesh and the viscera. The patient was discharged from the hospital after 18 hours. He has since been seen in follow-up and all bowel symptoms have resolved . . . [Full Text of this Article]

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