The diagnosis and evaluation of traumatic abdominal wall hernia can be challenging because of its low incidence and nonspecific clinical presentation. Without a high index of clinical suspicion, the detection of traumatic abdominal wall hernia may be delayed. A 71-year-old female patient was struck in the lower abdomen by a cow horn and initially received only conservative management at a local clinic. However, her pain worsened despite conservative measures, and she developed a reducible bulging mass. Computed tomography revealed an abdominal wall defect with small bowel herniation. She was transferred to our hospital's emergency department, where urgent surgery was performed. A laparotomy was conducted to repair the abdominal wall defect and explore potential intra-abdominal injuries. The defect was successfully repaired, and the patient was discharged without complications on postoperative day 10.

Spigelian hernias are a rare type of abdominal wall hernia. A weakness in the spigelian fascia causes abdominal contents to herniate between the abdominal muscle layers as an interparietal hernia. We present the case of a 72-year old woman with acute onset abdominal pain and distention. A computed tomography scan revealed an incarcerated spigelian hernia with small bowel obstruction. This necessitated an acute surgical intervention with a laparoscopic tissue repair. The case is unique as our patient had a large hernial neck measuring 4.8 centimeters, one of the largest in published literature. The laparoscopic tissue repair is outside the current norm for this type of hernial repair and remains a rare type of surgical herniorrhaphy. Laparoscopic ventral hernia repair in the acute setting should form part of the surgical skill set of acute care surgeons as borne out by the published literature and this case report.