Spiegel’s hernia, also called ventral lateral hernia, is a rare form of hernia that occurs in the abdominal wall. An organ is moving abnormally forward in the abdomen. Surgical management is necessary to limit the risk of complications.

Definition of Spiegel’s hernia

A hernia is the protrusion of an organ or part of an organ out of its usual position. Spiegel’s hernia (Spigel or Spieghel) is a rare form of hernia that occurs in a particular anatomical structure of the abdominal wall: the Spiegel line. It is like a zone of weakness, an “empty space” between several lateral muscles of the abdominal wall.

There are two lines of Spiegel, one on each side of the abdominal wall. To better visualize them, they are parallel to the white line (midline of the abdominal wall). For simplicity’s sake, Spiegel’s hernia is also referred to as a lateral ventral hernia.

Causes and risk factors

Spiegel’s hernia is usually acquired, that is, not present at birth. It occurs during life as a result of increased pressure in the abdomen. Several risk factors have been identified. Among them are in particular:

• obesity;
• the pregnancy ;
• chronic constipation;
• carrying heavy loads repeatedly.

Spiegel’s hernie diagnosis

The presence of Spiegel’s hernia can be seen by palpation of the abdominal wall. In some cases, physical examination may not be sufficient to confirm the diagnosis. In particular, medical imaging examinations may be performed to confirm Spiegel’s hernia in obese people, in the event of a small hernia that is barely palpable or in the event of a large hernia that may be mistaken for a tumor.

People affected by Spiegel’s hernia

While abdominal hernias are quite common, Spiegel’s hernia is a rare form. It is estimated to represent between 0,1% and 2% of abdominal wall hernias. It is most often seen in people aged 40 or over.

A Spiegel’s hernia is usually asymptomatic. No symptoms are felt. Spiegel’s hernia may present as a small lump at the Spiegel line. It may cause slight discomfort.

Risk of complications

A hernia is characterized by the protrusion of an organ or part of an organ out of its usual position. The risk is the strangulation of this organ, which can cause physiological dysfunction. For example, we can see a partial or complete stop of intestinal transit when the small intestine is found permanently tight. This condition, called bowel obstruction, can manifest as severe persistent pain, nausea and vomiting.

The management of Spiegel’s hernia is surgical. Most often, it involves placing a prosthesis in order to avoid abnormal organ displacement at the level of the Spiegel line.

Prevention consists of limiting the risk factors. It may thus be advisable to fight against weight gain by adopting a healthy lifestyle with good eating habits and the practice of regular physical activity.