Images in Clinical Medicine

Spigelian Hernia

Susana M. Campos, M.D., and Thomas Walden, M.D.

N Engl J Med 1997; 336:1149April 17, 1997

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Figure 1 Abdominal computed tomography, with the administration of oral and intravenous contrast material, was performed in a 40-year-old woman with long-standing pain in the right lower quadrant and a three-day history of nausea, vomiting, and right-flank pain. For years, the patient had been able to relieve her abdominal pain by applying pressure over the right lower quadrant. The abdominal examination was normal, except for tenderness in the right lower quadrant. The scan showed that a loop of colon (arrow) had herniated through the spigelian line and lay between the internal and external oblique muscles. The patient refused surgery and left the hospital against medical advice.

Susana M. Campos, M.D.
Brigham and Women's Hospital, Boston, MA 02115

Thomas Walden, M.D.
National Cancer Institute, Bethesda, MD 20892