Spigelian Hernia The Rare Type That's Hard to Diagnose
The Spigelian hernia is among the rarest and hardest to diagnose. Learn its hidden location, symptoms, and why it needs special attention.
In this article
The Spigelian hernia is among the rarest hernia types, characterised by occurring in a hidden location within the abdominal wall between muscle layers, making it one of the hardest to diagnose. Unlike a hernia visible directly under the skin, Spigelian may not form an obvious bulge, staying hidden until complications appear. To understand the difference between it and other types, see what is a hernia and its types.
Why Is the Spigelian Hernia Hard to Diagnose?
Deep Location
Occurs between abdominal muscle layers, not directly under the skin, so it often forms no clear bulge.
Rarity
Because it's rare, it may not be the first thing an examiner considers, delaying diagnosis.
Vague Symptoms
May cause localised pain without a clear mass, being misdiagnosed as muscular pain or other causes.
Strangulation Risk
Its opening is relatively small, raising the risk of tissue incarceration and strangulation.
Symptoms of Spigelian Hernia
The most common symptom is pain in the side of the abdomen below the navel, which may increase with exertion. Sometimes a slight bulge is noticed, but often pain is the only symptom. Because these symptoms are non-specific, imaging (ultrasound or CT) is frequently necessary to confirm the diagnosis.
Despite its rarity, the Spigelian hernia is considered higher risk for strangulation due to its small opening. So surgical repair is always advised upon diagnosis, and it's not left for monitoring like some other types.
How Is the Spigelian Hernia Treated?
Treatment is always surgical upon diagnosis, due to the high strangulation risk. It can be repaired open or laparoscopic hernia surgery, often using surgical mesh to strengthen the area and prevent recurrence. Laparoscopic surgery is especially useful in this type as it allows precise viewing of the deep location. The doctor decides based on the hernia's size and the patient's condition.
"The Spigelian hernia teaches us an important lesson: not every hernia appears as a clear bulge. Sometimes vague pain in the side of the abdomen is the only clue, and precise imaging is what reveals the truth."
Dr. Mohamed EsmatFrequently Asked Questions
Is the Spigelian hernia dangerous?
Yes, despite its rarity it's considered higher risk for strangulation due to its small opening, so repair is always advised upon diagnosis.
How is the Spigelian hernia detected?
It often needs ultrasound or CT imaging, because clinical examination alone may not reveal it due to its deep location.
Can it be treated laparoscopically?
Yes, laparoscopic surgery is especially useful in this type for its precision in reaching the deep location. The doctor decides what's best.
Suffering Vague Pain in the Side of Your Abdomen?
Book an assessment with Dr. Mohamed Esmat; some hernia types need careful examination to detect.
Dr. Mohamed Esmat
Consultant hernia and abdominal wall surgeon, PhD in General Surgery and founder of Hernia Core — the first Arab clinics dedicated to hernia surgery. 15+ years of experience and over 5,000 successful cases.
This article is for general medical awareness only and does not replace a consultation with a specialist. To assess your case, please book with Dr. Mohamed Esmat. Last reviewed: August 9, 2026.
