Introduction lumbar hernias occur infrequently and can be congenital, primary inferior or petit type, and superior or grynfeltt type, posttraumatic, or incisional. Most common in patients aged between 50 and 70 years with a male predominance 1. Lumbar hernia is a rare abdominal wall defect and clinical suspicion is necessary for diagnosis. Groin hernias are most commonly of the inguinal type but may also be femoral. Lumbar herniation occurs through the petits or the grynfelttlesshaft triangles. Ct can reveal traumatic lumbar hernia and show both the anatomy of disrupted muscular layers and the presence of herniated intraabdominal viscera or retroperitoneal fat. Lumbar hernia is probably the most uncommon abdominal hernia type, with approximately 300 cases reported in the literature 1,2. Lumbar hernia is a rarely encountered posterior ventral hernia, 1 which accounts for 2016. According to hafner et al, 1 a general surgeon will only have the opportunity to repair 1 lumbar hernia case in his or her lifetime. In fact, this hernia occurs so infrequently that only an occasional surgeon has the opportunity of seeing and repairing one through the course of his entire life. A lumbar hernia is best defined as a protrusion of either.
A lumbar hernia following an iliac crest bone graft harvesting is a rare complication which is more frequent in females than males. The neck of this hernia is usually large, and therefore, it has a lower risk of strangulation than other hernias 1. Department of surgery, university of washington introduction. This study was done to study the incidence, age at presentation, sex, associated anomalies, surgical management, and postoperative morbidity and mortality of congenital lumbar hernia in pediatric patients. Only 2 of the hernias were found in inferior triangle of petit. Full text onlay mesh repair for spontaneous lumbar hernia. Superior lumbar triangle radiology reference article. Patients with lumbar hernias can present with a variety of symptoms, including a posterolateral mass, back pain, bowel obstruction if contents contain bowel, or urinary obstruction if contents are. Lumbar hernia account for less than 2% of al abdominal hernias, been the.
Lumbar hernia is a protrusion of either extraperitoneal fat or intraperitoneal contents through either of the lumbar triangles. Macchi v, porzionato a, morra a, picardi ee, stecco c, loukas m et al 2016 the triangles of grynfeltt and petit. Clinical presentation patients with lumbar hernias can present with a variety of sym. The current management of lumbar hernias should reflect the development of modern imaging techniques and new forms of noninvasive treatment. The anatomy of the triangles is variable and quantitative data are few. Request pdf incarcerated inferior lumbar petit s hernia petits hernia is an uncommon abdominal wall defect in the inferior lumbar triangle. The transverse abdominis plane tap block is a peripheral nerve block designed to anesthetize the nerves supplying the anterior abdominal wall t6 to l1. Sundaramurthy s, suresh hb, anirudh av, prakash rozario a. Superior lumbar hernia is more common than the inferior and it originates in the superior triangle. It was first described in 2001 by rafi as a traditional blind landmark technique using the lumbar triangle of. The triangles of grynfeltt and petit and the lumbar tunnel. Petits hernia is described as herniation of retroperitoneal fat through the aponeurosis of the internal abdominal oblique muscle between the erector spinae muscles in the inferior lumbar triangle. Suggested by adrev masters admin sweet victory as featured in spongebob squarepants.
Most commonly they involve the abdomen, specifically the groin. It herniates through the superior lumbar triangle grynfelttlesshaft triangle or inferior lumbar triangle petit triangle. Lumbar hernias are rare clinical entities with less than 400 reported in the literature. Lumbar hernias manifest through two possible defects in the posterior abdominal wall, the superior being more common. Indeed, to the best of our knowledge, no more than 30 cases of strangulated lumbar hernia. The most common angle grynfeltts hernia, lasgafts her feature is a protrusion in the flank des nia, or larreys iliac crest hernia, or lumbar hernias are very rare defects of cribed by the patient and often diagno the inferior lumbar triangle petits the abdominal wall, representing 2% of sed as a lipoma or parietal tumor lumbar hernia. The correct diagnosis was made intraoperatively and the hernia was repaired using synthetic mesh.
Fifty computed tomography angiography of the upper abdomen m25, f25, mean age. Pitfalls and clinical recommendations for the primary lumbar hernia. Primary lumbar hernias are extremely rare thereby rendering such a case reportable. Apr 28, 2015 petit s hernia is a hernia that protrudes through the lumbar triangle this video contains general medical information if in doubt, always seek professional medical advice. A petits lumbar hernia is, indeed, an extremely rare defect. We present a rare case of inferior lumbar hernia, leading to mechanical bowel obstruction, successfully treated with prosthetic mesh. With approximately 300 cases published in the literature, the general surgeon may have the chance of treat it ones in their professional life. The lumbar region is the area of muscles that cover the lower back, from the bottom of the rib cage to the top of the pelvis. The neck the spot where the hernia protrudes into the opening is large, and therefore this hernia has a lower risk. It can be classified as congenital or acquired, which may be primary or secondary. Open and laparoscopic surgery, as well retromuscular lumbar hernia repair, are options to explore in. Management remains surgical with various techniques emerging over the years. Oct 30, 2015 lumbar hernia is an uncommon abdominal wall hernia, making its diagnosis and management a challenge to the treating surgeon. An imaging study forms an indispensable aid in the diagnosis and surgery is the only treatment option.
Petit lumbar herniaa doublelayer technique for tension. It stems from a traumatic injury auto accident 10 yrs ago. A lumbar hernia is a rare pathological derangement of anatomy, especially when the postoperative type is excluded. May 23, 2016 lumbar hernias are protrusions of intraabdominal contents classically through the superior grynfeltt and inferior petit lumbar triangles. Congenital hernias appear during infancy as the origin of a defect in the musculoskeletal system of the lumbar region, and are associated with other. A lumbar hernia may be primary or secondary with only about 300 cases of primary lumbar hernia reported in literature. Five studies 9, 10, , 16, 19 used the open approach for the repair of the lumbar hernia, one study 8 only included patients with a. Lumbar hernias are a rare form of posterior abdominal hernia.
Classification, diagnosis and treatment are updated. Awareness of the anatomical basis of this hernia is important for proper diagnosis and treatment. A petit s lumbar hernia is, indeed, an extremely rare defect. Dec 26, 2017 a spigelian hernia is a hernia through the spigelian fascia or layer of tissue that separates two groups of abdominal muscles. Few studies exist to support a standard protocol for repair of these lateral hernias. A 70yearold male with a reducible left sided superior lumbar hernia. Download as pdf print show related cases notify admin. Controversies in the current management of lumbar hernias. Full text onlay mesh repair for spontaneous lumbar. Colonic incarceration through the inferior lumbar triangle, which causes mechanical obstructive symptoms, necessitates particular diagnostic and management strategy. A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides.
No radiological data on the anatomy of the triangles are available. Laparoscopic treatment of incisional lumbar hernia. Today, this situation in many centers has changed with the creation of functional units where patients can. A lumbar hernia is defined as the abdominal organs or retroperitoneal fat protruding although defect areas in the lumbar region. A primary inferior lumbar hernia misdiagnosed as a lipoma. Many surgeons are not familiar to lumbar hernias, which frequently leads to misdiagnosis and delay of treatment. Lumbar hernias represent 2% of all abdominal hernias 1, 2. It occurs anywhere between the 12 th rib and the iliac crest, and it can be congenital or acquired. Congenital lumbar hernia is an uncommon anomaly with only few cases reported in the english literature. Incarcerated inferior lumbar petits hernia request pdf. Incarcerated inferior lumbar petits hernia, hernia 10. Petit and grynfelt delineated the boundaries of the superior and the inferior triangles, named. This triangle lies in the posterolateral abdominal wall and is bounded anteriorly by the free margin of external oblique muscle, posteriorly by the latissimus dorsi and inferiorly by the iliac crest.
Most postoperative incisional hernias occur in nephrectomy or aortic aneurysm repair incisions. Fifty computed tomography angiography of the upper abdomen m25, f25, mean age 72. Grynfeltts lumbar hernia is a rare abdominal wall pathology with around 300 cases described in the literature. Petit and grynfeltt described the anatomical boundaries. Other hernias include hiatus, incisional, and umbilical hernias. Lumbar hernia is a relatively rare defect of the posterior abdominal wall, with approximately 300 cases reported in the literature. Lumbar hernias are very infrequent posterior abdominal wall defects.
Petits hernia is a hernia that protrudes through the lumbar triangle. Barbette, in 1672, made the first description of this entity, while garangeot published the first case in 1731. We hypothesized that anchoring our repair to fixed bony structures would reduce recurrence rates. Hernias that occur through the superior lumbar space or grynfeltlesshaft, as this is more consistent and larger, often appear more frequently than those produced through the triangle of petit. Primary lumbar hernias are extremely rare thereby rendering such a case reportable, to. Retrospective analysis of all patients of clh over a.
Lumbar hernias are protrusions of intraabdominal contents classically through the superior grynfeltt and inferior petit lumbar triangles. To date, approximately 300 cases of lumbar hernia have been reported in the literature. Presentation may be misleading and diagnosis often missed. In most cases, lumbar hernias are the result of aging. Lumbar hernias occur in a area of the back called the lumbar triangle. Pdf lumbar hernias develop through the weakening of the posterolateral abdominal wall associated with the petits triangle or the. Backgroundobjetives lumbar hernias are rare sumamentes less than 1% and reported rarely. Pitfalls and clinical recommendations for the primary. Lumbar hernia is an uncommon abdominal wall hernia, making its diagnosis and management a challenge to the treating surgeon. Petits hernia is an uncommon abdominal wall defect in the inferior lumbar triangle.
The objective of this study was to determine the ct findings of traumatic lumbar hernia in 15 patients and to discuss the mechanism and treatment of injury. A lumbar hernia an uncommon type of abdominal hernia that develops in the lumbar region of the back. The patient was free of recurrence at 4 months after. A lumbar hernia is a posterolateral body wall hernia where the bowel, omentum, or preperitoneal fat herniates through the lumbar triangles. This medical picture shows a czase of a large lumbar hernia. Lumbar hernia account for less than 2% of al abdominal hernias, been the grynfeltlesshafts hernia glh more frequent than the others. Apr 10, 2003 petit s hernia is an uncommon abdominal wall defect in the inferior lumbar triangle.
Lumbar hernia is an uncommon abdominal wall hernia, making its diagnosis and. Eighty percent of lumbar hernias are acquired, meaning they develop over time due to weakness of the abdomen wall and loss of muscle and fatty tissue related to aging, illness, trauma, or back surgery. May 22, 2016 ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except groin hernias. It is named after french surgeon jean louis petit 16741750. A commonly misevaluated condition of the bilateral. Cureus management criteria of grynfeltts lumbar hernia. Nov 08, 2016 lumbar hernia is a wellrecognized clinical condition that is rarely encountered, 1,4,5 with only around 300 cases reported in the literature. Lumbar hernia misdiagnosed as a subcutaneous lipoma. Petits triangle is bound by the anterior border of the external oblique muscle, the posterior border of the latissimus dorsi muscle, and the inferior border of the iliac crest. The superior lumbar triangle, also known as the triangle of grynfelttlesshaft, is one of the locations for a lumbar hernia. Lumbar hernias can be congenital or the result of injury or trauma to the back or abdomen. Sublay repair for primary superior lumbar hernia with the. Looking to find a surgeon to repair it, it is a risky procedure and only 300 cases have ever been documented. Petit s hernia is a hernia that protrudes through the lumbar triangle.
Lumbar, pelvic, and uncommon hernias sciencedirect. The muscles are called the rectus muscles and the lateral obliques. Petit later characterized the inferior lumbar triangle hernia in 1783 and grynfeltt the superior lumbar triangle hernia. Recently, a therapeutically aimed classification was proposed analysing the size, location, contents, muscular atrophy, origin, and existence of the previous recurrence. Barbette suggested the entity of a lumbar hernia in 1672, but the first published case in the medical literature was in 1731 by degarangeot. Epidemiology most common in patients aged between 50 and 70 years with a male predominance 1. Laparoscopic lumbar hernia repair sages abstract archives.
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