Spigelian hernia: Uncommon or unrecognized?

Spigelian hernia may be a more common clinical entity than previously recognized or reported. We report seven cases, four diagnosed and treated in the past 12 months at a large military hospital. Diagnosis can be difficult because of failure to consider it, incomplete understanding of the anatomy, and the nonpalpable intraparietal nature of the hernia. A careful history and physical examination are essential. Any patient with persistent localized pain in the proper anatomic location—just lateral to the outer border of the rectus muscle and usually below the umbilicus—warrants surgical exploration.