Strangulated Spigelian Hernia With Small Bowel Obstruction Requiring Intestinal Resection: An Uncommon Cause of Acute Abdomen.

Spigelian hernia is a rare abdominal wall hernia. It occurs more commonly in women between the fifth and seventh decades of life and is typically located within the Spigelian belt. Because of its interparietal location and small fascial defect, diagnosis may be challenging, and the risk of incarceration and strangulation is high. We present the case of a 64-year-old woman who presented to the emergency department with abdominal pain, nausea, and obstipation. Clinical evaluation was consistent with an acute abdomen secondary to intestinal obstruction. Emergency exploratory laparotomy revealed a Spigelian hernia containing a strangulated segment of terminal ileum with associated bowel necrosis. Segmental small bowel resection with primary anastomosis was performed. The postoperative course was uneventful, with gradual reintroduction of oral intake, and the patient was discharged on postoperative day seven without complications. Spigelian hernia should be considered in the differential diagnosis of patients presenting with acute abdomen and intestinal obstruction without an evident cause. Early diagnosis and prompt surgical intervention are essential to prevent complications such as bowel ischemia, necrosis, and perforation. This case highlights the clinical importance of maintaining a high index of suspicion for this uncommon entity in emergency surgical practice.