{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T00:38:30Z","timestamp":1793407110958,"version":"4.5.0"},"reference-count":18,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,7,28]]},"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:p>Spigelian hernia is a rare form of abdominal wall defect. Bilateral Spigelian hernias are even less common. Surgical repair of Spigelian hernias is recommended due to their high risk of incarceration and strangulation of abdominal contents. A variety of surgical approaches to repair these hernias have been described in the literature including the traditional open approach, laparoscopic transabdominal preperitoneal approach, laparoscopic intraperitoneal repair and laparoscopic totally extraperitoneal repair. Here, we present the case of an elderly female patient with rare bilateral Spigelian hernias, the right side containing incarcerated appendix and caecal pole. The left hernia was unrecognised on preoperative CT imaging. To our knowledge, very few cases have been reported in the literature. The patient underwent bilateral laparoscopic intraperitoneal mesh repair. All technical aspects of the treatment are discussed here, in the context of the current literature, including the surgical technique and the limitations of the CT diagnosis. We aim to summarise the background of these uncommon hernias, the limitations of preoperative investigations and the differences between the available operative approaches.<\/jats:p>","DOI":"10.1136\/bcr-2022-251931","type":"journal-article","created":{"date-parts":[[2023,8,8]],"date-time":"2023-08-08T11:07:34Z","timestamp":1691492854000},"page":"e251931","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Diagnosis and treatment of a rare case of an incarcerated bilateral Spigelian hernia with the vermiform appendix and caecum"],"prefix":"10.1136","volume":"16","author":[{"given":"Neil Robert","family":"Lowrie","sequence":"first","affiliation":[{"name":"General Surgery, University of Otago School of Medicine, Dunedin, New Zealand"},{"name":"General Surgery, Southland Hospital, Invercargill, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0299-8751","authenticated-orcid":false,"given":"Konrad Klaus","family":"Richter","sequence":"additional","affiliation":[{"name":"General Surgery, Southland Hospital, Invercargill, New Zealand"},{"name":"Dean's Department, University of Otago School of Medicine, Dunedin, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mavis N","family":"Orizu","sequence":"additional","affiliation":[{"name":"General Surgery, Southland Hospital, Invercargill, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,8,8]]},"reference":[{"key":"2025082722402876000_16.8.e251931.1","doi-asserted-by":"publisher","DOI":"10.1148\/112.2.309"},{"key":"2025082722402876000_16.8.e251931.2","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1148\/radiographics.15.2.7761638","article-title":"Abdominal wall hernias: review of herniography and correlation with cross-sectional imaging","volume":"15","author":"Harrison","year":"1995","journal-title":"Radiographics"},{"key":"2025082722402876000_16.8.e251931.3","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-002-6605-0"},{"key":"2025082722402876000_16.8.e251931.4","doi-asserted-by":"crossref","first-page":"95","DOI":"10.4103\/0972-9941.45204","article-title":"Diagnosis and management of Spigelian hernia: a review of literature and our experience","volume":"4","author":"Mittal","year":"2008","journal-title":"J Minim Access Surg"},{"key":"2025082722402876000_16.8.e251931.5","doi-asserted-by":"crossref","DOI":"10.1093\/jscr\/rjaa115","article-title":"Strangulated spigelian hernia with necrosis of the caecum, appendix and terminal ileum: an unusual presentation in the elderly","volume":"2020","author":"Ndong","year":"2020","journal-title":"J Surg Case Rep"},{"key":"2025082722402876000_16.8.e251931.6","doi-asserted-by":"crossref","first-page":"e130","DOI":"10.1177\/000313481608200701","article-title":"Management of bilateral Spigelian hernias","volume":"82","author":"Afshari","year":"2016","journal-title":"Am Surg"},{"key":"2025082722402876000_16.8.e251931.7","doi-asserted-by":"crossref","unstructured":"Ong TH , Ong CYG , Tan MNA . 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Clin Case Studies Rep 6 2023. doi:10.15761\/CCSR.1000176","DOI":"10.15761\/CCSR.1000176"},{"key":"2025082722402876000_16.8.e251931.8","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1308\/003588413X13511609957092","article-title":"Radiological and clinical examination in the diagnosis of Spigelian hernias","volume":"95","author":"Light","year":"2013","journal-title":"Ann R Coll Surg Engl"},{"key":"2025082722402876000_16.8.e251931.9","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.137.11.1266"},{"key":"2025082722402876000_16.8.e251931.10","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.clinimag.2020.12.031","article-title":"MDCT imaging in Spigelian hernia, clinical, and surgical implications","volume":"74","author":"Azar","year":"2021","journal-title":"Clin Imaging"},{"key":"2025082722402876000_16.8.e251931.11","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1080\/08998280.2020.1822131","article-title":"Gangrenous appendicitis contained within a Spigelian hernia","volume":"34","author":"Anand","year":"2021","journal-title":"Baylor University Medical Center Proceedings"},{"key":"2025082722402876000_16.8.e251931.12","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/S0002-9378(11)91630-5","article-title":"Laparoscopic diagnosis and repair of Spigelian hernia: report of case and technique","volume":"167","author":"Carter","year":"1992","journal-title":"Am J Obstet Gynecol"},{"key":"2025082722402876000_16.8.e251931.13","doi-asserted-by":"crossref","first-page":"e86","DOI":"10.1097\/SLE.0000000000000112","article-title":"Laparoscopic Spigelian hernia repair: a series of 40 patients","volume":"25","author":"Kelly","year":"2015","journal-title":"Surg Laparosc Endosc Percutan Tech"},{"key":"2025082722402876000_16.8.e251931.14","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1007\/s10029-021-02511-8","article-title":"Spigelian hernia: current approaches to surgical treatment\u2014a review","volume":"26","author":"Hanzalova","year":"2022","journal-title":"Hernia"},{"key":"2025082722402876000_16.8.e251931.15","article-title":"Laparoscopic intraperitoneal mesh fixation with fibrin sealant of a Spigelian hernia","volume":"2","author":"Huber","year":"2013","journal-title":"GMS Interdiscip Plast Reconstr Surg DGPW"},{"key":"2025082722402876000_16.8.e251931.16","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1007\/s10029-006-0103-5","article-title":"Spigelian hernias: a prospective analysis of baseline parameters and surgical outcome of 34 consecutive patients","volume":"10","author":"Malazgirt","year":"2006","journal-title":"Hernia"},{"key":"2025082722402876000_16.8.e251931.17","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1097\/SLE.0b013e31820d66df","article-title":"Laparoscopic management of Spigelian hernias","volume":"21","author":"Skouras","year":"2011","journal-title":"Surg Laparosc Endosc Percutan Tech"},{"key":"2025082722402876000_16.8.e251931.18","doi-asserted-by":"crossref","DOI":"10.1186\/1757-1626-3-22","article-title":"An unusual Spigelian hernia involving the appendix: a case report","volume":"3","author":"Thomasset","year":"2010","journal-title":"Cases J"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2022-251931","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T05:40:38Z","timestamp":1756359638000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2022-251931"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8]]},"references-count":18,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,8,8]]},"published-print":{"date-parts":[[2023,8]]}},"alternative-id":["10.1136\/bcr-2022-251931"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2022-251931","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8]]}}}