{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T09:17:49Z","timestamp":1778663869324,"version":"3.51.4"},"reference-count":16,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Spigelian hernias represent infrequent abdominal wall defects, and the incarceration of an inflamed appendix within the hernia sac is an even rarer clinical finding. We report an uncommon case in which a long-standing herniated appendix eventually progressed to perforation and abscess formation. Our report aims to illustrate this clinical transition to an atypical surgical emergency, while emphasizing that early Computed Tomography (CT) is vital for resolving diagnostic uncertainty and avoiding potential pitfalls in complex abdominal wall pathologies. Following prompt surgical intervention and hernia repair, the patient had an uneventful recovery and remained asymptomatic at the six-month follow-up.<\/jats:p>","DOI":"10.3390\/reports9020150","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T07:44:26Z","timestamp":1778658266000},"page":"150","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond the Abdominal Wall: Appendiceal Abscess Concealed Within a Spigelian Hernia"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8122-0872","authenticated-orcid":false,"given":"Ioannis","family":"Katsarelas","sequence":"first","affiliation":[{"name":"Department of General Surgery, General Hospital of Katerini, 60132 Katerini, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Panagiotou","sequence":"additional","affiliation":[{"name":"Department of General Surgery, General Hospital of Katerini, 60132 Katerini, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad","family":"Husamieh","sequence":"additional","affiliation":[{"name":"Department of General Surgery, General Hospital of Katerini, 60132 Katerini, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6027-6378","authenticated-orcid":false,"given":"Ismini","family":"Kountouri","sequence":"additional","affiliation":[{"name":"Department of General Surgery, General Hospital of Katerini, 60132 Katerini, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Periklis","family":"Dimasis","sequence":"additional","affiliation":[{"name":"Department of General Surgery, General Hospital of Katerini, 60132 Katerini, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"108079","DOI":"10.1016\/j.ijscr.2023.108079","article-title":"Spigelian hernia: A rare case presentation and review of literature","volume":"105","author":"Shrestha","year":"2023","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1177\/000313480607200110","article-title":"Spigelian hernia: Surgical anatomy, embryology, and technique of repair","volume":"72","author":"Skandalakis","year":"2006","journal-title":"Am. Surg."},{"key":"ref_3","first-page":"e83098","article-title":"Spigelian Hernia Masquerading as Chronic Lower Abdominal Pain: A Case Report","volume":"17","author":"Lk","year":"2025","journal-title":"Cureus"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1056\/NEJM199704173361605","article-title":"Images in clinical medicine. Spigelian hernia","volume":"336","author":"Campos","year":"1997","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1001\/archsurg.1983.01390010081018","article-title":"Diagnosis of Spigelian Hernia by Computed Tomography","volume":"118","author":"Papierniak","year":"1983","journal-title":"Arch. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1055\/s-0034-1370771","article-title":"Spigelian Hernia in a 14-Year-Old Girl: A Case Report and Review of the Literature","volume":"2","author":"Spinelli","year":"2014","journal-title":"Eur. J. Pediatr. Surg. Rep."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e264840","DOI":"10.1136\/bcr-2025-264840","article-title":"Spigelian hernia containing an appendix","volume":"18","author":"Stubley","year":"2025","journal-title":"BMJ Case Rep."},{"key":"ref_8","first-page":"717","article-title":"Spigelian hernia: A rare case presentation","volume":"2","author":"Mhatre","year":"2016","journal-title":"Int. Surg. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e308","DOI":"10.1055\/s-0042-1758044","article-title":"Peri-appendicular Abscess in a Spigelian Hernia","volume":"8","author":"Aoun","year":"2022","journal-title":"Surg. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2701","DOI":"10.1111\/ans.17930","article-title":"Laparoscopic repair of a Spigelian hernia with appendicitis in situ","volume":"92","author":"Stanley","year":"2022","journal-title":"ANZ J. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"rjaa099","DOI":"10.1093\/jscr\/rjaa099","article-title":"An incarcerated Spigelian hernia with the appendix in the sac passing though all layers of the abdominal wall: An unusual cause for chronic right iliac fossa pain","volume":"2020","author":"Page","year":"2020","journal-title":"J. Surg. Case Rep."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e66","DOI":"10.1308\/003588413X13511609957731","article-title":"Appendicitis in a Spigelian hernia: An unusual cause for a tender right iliac fossa mass","volume":"95","author":"Thomas","year":"2013","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"bcr2017221851","DOI":"10.1136\/bcr-2017-221851","article-title":"Rare and unusual case of perforated appendicitis in a Spigelian hernia","volume":"2017","author":"Cox","year":"2017","journal-title":"BMJ Case Rep."},{"key":"ref_14","first-page":"312","article-title":"An unusual presentation of an incarcerated Spigelian hernia","volume":"117","author":"Peeters","year":"2017","journal-title":"Acta Chir. Belg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s13017-017-0149-y","article-title":"2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias","volume":"12","author":"Birindelli","year":"2017","journal-title":"World J. Emerg. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1177\/000313480707301221","article-title":"Amyand hernia: What lies beneath--a proposed classification scheme to determine management","volume":"73","author":"Losanoff","year":"2007","journal-title":"Am. 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