Fallopian Tube Masquerading as Small Bowel in a Spigelian Hernia: A Case Report

Abstract

Introduction: Spigelian hernias are rare abdominal wall hernias that occur through a defect in the Spigelian fascia, in the lower abdomen. Most commonly, these hernias contain omentum or small bowel, although rare cases involve pelvic organs like ovaries and fallopian tubes. Aim: This case report describes a rare case of an incarcerated Spigelian hernia containing a right-sided fallopian tube. Presentation of Case: A 52-year-old woman presented with a one-week history of intermittent right lower abdominal pain and a long-standing swelling in the same region. She had prior history of lower midline laparotomy for ectopic pregnancy, over 20 years ago. Imaging with contrast-enhanced computed tomography (CT) revealed the presence of small bowel within a Spigelian hernia. However, during laparoscopic surgery, the hernia defect was found to contain the right fallopian tube. The hernia was repaired using an intraperitoneal onlay mesh technique, and the patient was discharged on postoperative day 2. Discussion: Spigelian hernias present a diagnostic challenge due to its rarity and the masking of defect by abdominal wall fat and musculature. Imaging such as CT scans are usually required to confirm the diagnosis and identify hernia contents. In women, pelvic organs should be considered as potential hernia contents. Due to the high risk of strangulation, surgical intervention is recommended for symptomatic patients. Laparoscopic repair remains the preferred method, offering reduced morbidity, shorter hospital stays, and less postoperative pain. Conclusion: This case highlights the rarity of fallopian tube involvement in Spigelian hernias and the importance of a high index of suspicion in diagnosis and treatment planning.