Rare case of Ischaemic Meckel’s diverticulum in spigelian hernia

Abstract

Ischemic Meckel’s diverticulum in Spigelian hernia is a rare condition and poses a significant diagnostic and management challenges. Spigelian hernia is a rare type of acquired ventral hernia that accounts for 1-2% of all abdominal wall hernias. We present a rare case of a 59-year-old female patient who presented with incarcerated abdominal wall hernia. The preoperative CT scan showed left sided abdominal wall hernia and not bowel obstruction. However, intra-operatively patient had an ischaemic small bowel segment and a necrotic Meckel’s diverticulum in Spigelian hernia. The patient underwent a laparoscopic procedure converted to open repair of spigelian hernia with resection of small bowel containing ischaemic Meckel’s diverticulum.  Patient’s post-operative recovery course was unremarkable and diet was gradually upgraded. Incarcerated/ischaemic Meckel’s diverticulum in a Spigelian hernia is rare and may present with significant pre-operative diagnostic challenges. CT or MRI could be helpful diagnostic modalities. Both open or laparoscopic repairs could be performed depending on clinical situations.