A Case of Port-site Herniation in the Spigelian Aponeurosis

Abstract

A 52-year-old woman underwent a laparoscopic appendectomy for acute appendicitis after failed conservative treatment. During the surgery, a 12-mm port was inserted at the umbilicus and left lower abdomen, and a 5-mm port on the pubic bone. She began to vomit on postoperative day 2, and a skin bulge was observed below the 12-mm port wound in the left lower abdomen, followed by the patient complaining of left lower abdominal pain. Abdominal CT performed on the same day revealed an incarcerated portion of the small intestine in the 12-mm port wound. The diagnosis of strangulated intestinal obstruction due to a port-site hernia was made, and emergency surgery was performed. The port wound was found on the external edge of the abdominal rectus muscle, which is the Spigelian aponeurosis. When the incarcerated intestine was removed from the wound of the 12-mm port in left lower abdomen, necrosis was suspected, and partial resection of the small intestine was performed. The Spigelian aponeurosis lacks a posterior capsule in the rectus abdominis muscle, making it anatomically fragile and a risk factor for the development of port-site hernia. Herein, we report our case with some discussion of the relevant literature.