Incarcerated Spigelian Hernia: A Case Report.

Spigelian hernia (SH) is a rare abdominal wall defect that frequently presents a diagnostic challenge because of its non-specific symptoms and deep anatomical location. We report the case of a 64-year-old woman with adequately controlled hypertension who presented with localized abdominal wall pain and a long-standing lateral abdominal bulge. Physical examination revealed an incarcerated SH without signs of strangulation or bowel obstruction. Computed tomography confirmed a Spigelian fascial defect containing incarcerated ileal loops without evidence of bowel compromise, allowing appropriate preoperative planning. The patient underwent elective open hernioplasty with polypropylene mesh placement without intraoperative complications. Postoperative recovery was uneventful, with satisfactory wound healing and progressive return to normal daily activities. At six months of follow-up, the patient remained asymptomatic, with no evidence of recurrence or mesh-related complications. This case highlights the importance of maintaining a high index of suspicion for SH in patients presenting with lateral abdominal wall pain or swelling. Computed tomography remains a valuable diagnostic tool for confirming the diagnosis and facilitating surgical planning, while timely mesh repair represents a safe and effective treatment option that may prevent progression to incarceration, strangulation, and bowel compromise.