Giant spigelian hernia in an elderly woman: a case report.

Introduction and importance: Spigelian hernias are an uncommon type of abdominal hernia, constituting just 1-2% of all cases. These hernias develop through defects in the abdominal wall near the semilunar line. Their rarity and subtle presentation often complicate preoperative diagnosis. The case highlights the challenges of diagnosing and managing Spigelian hernias in low- and middle-income countries, where access to advanced diagnostic tools like imaging and specialized surgical care is limited, complicating patient management. Case presentation: This case involves an elderly woman with no known chronic conditions, not on any medication, and no prior surgical history, who presented with a history of a prolonged, large, nonreducible swelling. Due to lack of access to preoperative imaging, clinical evaluation was used to guide surgical management, leading to a successful repair. Clinical discussion: Spigelian hernias often present without clear symptoms, making them difficult to diagnose, especially in settings with limited diagnostic resources like ultrasound or CT. In this case, the hernia involved multiple abdominal structures, which posed a significant risk for complications such as strangulation. Early surgical intervention is critical, particularly for elderly patients who are at higher risk. Conclusion: This case demonstrates the importance of prompt surgical intervention in managing Spigelian hernias and the challenges faced in resource-limited settings. The Operation Hernia, A Global outreach program at no cost, provided crucial access to expert care in underserved regions, significantly improving patient outcomes.