External abdominal wall hernias in rare locations

Rarely localized external abdominal wall hernias represent a poorly studied yet clinically significant group of conditions characterized by atypical anatomical locations, a wide variety of anatomical variants, and a high rate of diagnostic errors. These hernias often present with subtle or nonspecific clinical manifestations and are frequently diagnosed at the stage of complications, which is associated with an increased risk of incarceration, postoperative complications, and mortality. The review article analyzed 45 full-text articles from electronic library databases and systematized modern information on rare external hernias of the abdominal cavity, including hernias of the Spigelian line, obturator foramen, sciatic, perineal hernias, hernias of the xiphoid process of the sternum and lumbar hernias. The clinical features, anatomical and morphological prerequisites for the formation of hernia defects, as well as the main diagnostic challenges are analyzed. The role of staging is noted, which is important for determining diagnostic tactics and choosing the optimal treatment method, especially considering the patient's age and, as a consequence, the risk of complications. Particular attention is paid to the role of imaging modalities, primarily computed tomography, as well as diagnosticlaparoscopy, in the timely detection of these types of hernias. It has been shown that rare hernias of the anterior abdominal wall represent a diagnostically and tactically complex group of pathologies, often detected only at the stage of complications. It is shown that the choice of surgical strategy should be individualized and determined by thelocation of the hernia defect, the presence of complications, and the patient’s comorbid status. Analysis of the availableliterature highlights the need for the standardization of diagnostic approaches and further accumulation of clinical experience in order to improve surgical outcomes in patients with rare external abdominal wall hernias.

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