Traumatic Spigelian hernia following bicycle handlebar injury: A case report

Traumatic Spigelian hernia is an exceptionally rare clinical entity, often resulting from low-velocity, high-pressure blunt force, such as a bicycle “handlebar injury.” It may pose a diagnostic challenge and can be associated with occult intra-abdominal pathologies. A 39-year-old female presented with a reducible right iliac fossa swelling and dull aching pain 7 days after a bicycle handlebar impact. She also reported nonpassage of stools for 48 h without features of bowel obstruction. Clinical examination and ultrasonography suggested a traumatic abdominal wall hernia. Contrast-enhanced computed tomography (CECT) confirmed a 1.85-cm defect in the right Spigelian fascia containing bowel loops and omentum. It also revealed an incidental, right adnexal mass of 6.5 cm × 8.2 cm × 7 cm with fat attenuation and calcific foci, suggestive of a mature cystic teratoma. The patient underwent open surgical exploration. The hernia was repaired using a sublay (preperitoneal) synthetic mesh technique. Simultaneously, a right ovarian cystectomy was performed. The postoperative course was uneventful, and the patient was discharged on the fifth postoperative day. Histopathological examination confirmed a mature cystic teratoma. On follow-up, the surgical site healed well with no evidence of recurrence. This case report highlights the “handlebar hernia” as a diagnostic challenge that requires a high index of clinical suspicion. CECT remains the gold standard for identifying fascial defects and associated intra-abdominal pathologies. Early imaging and thorough surgical exploration enable single-stage management of traumatic hernias and incidental findings, with sublay mesh repair providing a reliable and effective treatment approach for traumatic Spigelian hernias.