A spigelian hernia is an uncommon hernia of the anterior abdominal wall. We herein report a case of spigelian hernia, pre-operatively diagnosed as an incisional hernia. A 61-year-old woman had undergone an abdominal hysterectomy 14 years prior to her admission to our hospital complaining of a left lower abdominal mass with recurring pain. At the time of the operation the hernial orifice appeared not to be related to her previous surgical scar, but was located at the spigelian fascia below the level of the umbilicus. The hernial sac was dissected and the defect of the abdominal wall was closed. The diagnosis of a spigelian hernia can be difficult because of its nonspecific clinical findings and insidious nature. Diagnostic procedures and differential diagnosis are herein discussed with a review of the literature.
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