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. Fifty computed tomography angiography of the upper abdomen m25, f25, mean age. Pitfalls and clinical recommendations for the primary lumbar hernia. Pdf lumbar hernias develop through the weakening of the posterolateral abdominal wall associated with the petits triangle or the. Herniation can occur through the grynfelttlesshaft triangle i. 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. Controversies in the current management of lumbar hernias. We present a rare case of inferior lumbar hernia, leading to mechanical bowel obstruction, successfully treated with prosthetic mesh. Request pdf incarcerated inferior lumbar petit s hernia petits hernia is an uncommon abdominal wall defect in the inferior lumbar triangle. Indeed, to the best of our knowledge, no more than 30 cases of strangulated lumbar hernia. They are usually located in the upper lumbar triangle and represent approximately 1. 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.
A lumbar hernia is defined as the abdominal organs or retroperitoneal fat protruding although defect areas in the lumbar region. Lumbar hernias represent 2% of all abdominal hernias 1, 2. Petit and grynfeltt described the anatomical boundaries. Apr 10, 2003 petit s hernia is an uncommon abdominal wall defect in the inferior lumbar triangle. Incarcerated inferior lumbar petits hernia request pdf. Lumbar hernias are protrusions of intraabdominal contents classically through the superior grynfeltt and inferior petit lumbar triangles. 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. Full text onlay mesh repair for spontaneous lumbar.
The triangles of grynfeltt and petit and the lumbar tunnel. Incarcerated inferior lumbar petits hernia, hernia 10. Grynfeltts lumbar hernia is a rare abdominal wall pathology with around 300 cases described in the literature. Introduction lumbar hernias occur infrequently and can be congenital, primary inferior or petit type, and superior or grynfeltt type, posttraumatic, or incisional.
Full text onlay mesh repair for spontaneous lumbar hernia. A 70yearold male with a reducible left sided superior lumbar hernia. Most postoperative incisional hernias occur in nephrectomy or aortic aneurysm repair incisions. In most cases, lumbar hernias are the result of aging. It is named after french surgeon jean louis petit 16741750. Download as pdf print show related cases notify admin. A commonly misevaluated condition of the bilateral. Lumbar hernias are a rare form of posterior abdominal hernia. It can be classified as congenital or acquired, which may be primary or secondary. 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.
The neck the spot where the hernia protrudes into the opening is large, and therefore this hernia has a lower risk. 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. Petit s hernia is a hernia that protrudes through the lumbar triangle. With approximately 300 cases published in the literature, the general surgeon may have the chance of treat it ones in their professional life. Today, this situation in many centers has changed with the creation of functional units where patients can. Most commonly they involve the abdomen, specifically the groin. This medical picture shows a czase of a large lumbar hernia. Lumbar hernia is a protrusion of either extraperitoneal fat or intraperitoneal contents through either of the lumbar triangles. Lumbar hernia is an uncommon abdominal wall hernia, making its diagnosis and management a challenge to the treating surgeon. It was first described in 2001 by rafi as a traditional blind landmark technique using the lumbar triangle of. Lumbar hernia misdiagnosed as a subcutaneous lipoma.
Congenital lumbar hernia is an uncommon anomaly with only few cases reported in the english literature. Open and laparoscopic surgery, as well retromuscular lumbar hernia repair, are options to explore in. We hypothesized that anchoring our repair to fixed bony structures would reduce recurrence rates. The correct diagnosis was made intraoperatively and the hernia was repaired using synthetic mesh. Lumbar hernia is an uncommon abdominal wall hernia, making its diagnosis and. Barbette suggested the entity of a lumbar hernia in 1672, but the first published case in the medical literature was in 1731 by degarangeot. Barbette, in 1672, made the first description of this entity, while garangeot published the first case in 1731. Clinical presentation patients with lumbar hernias can present with a variety of sym. 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.
Lumbar hernia account for less than 2% of al abdominal hernias, been the. 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. Lateral abdominal wall hernias are rare defects but, due to their location, repair is difficult, and recurrence is common. Petit and grynfelt delineated the boundaries of the superior and the inferior triangles, named.
Dec 26, 2017 a spigelian hernia is a hernia through the spigelian fascia or layer of tissue that separates two groups of abdominal muscles. 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. Epidemiology most common in patients aged between 50 and 70 years with a male predominance 1. The transverse abdominis plane tap block is a peripheral nerve block designed to anesthetize the nerves supplying the anterior abdominal wall t6 to l1. No radiological data on the anatomy of the triangles are available. Lumbar hernias are rare clinical entities with less than 400 reported in the literature. Backgroundobjetives lumbar hernias are rare sumamentes less than 1% and reported rarely. Department of surgery, university of washington introduction.
Lumbar hernias occur in a area of the back called the lumbar triangle. A lumbar hernia may be primary or secondary with only about 300 cases of primary lumbar hernia reported in literature. Lumbar, pelvic, and uncommon hernias sciencedirect. Sundaramurthy s, suresh hb, anirudh av, prakash rozario a. Petits hernia is an uncommon abdominal wall defect in the inferior lumbar triangle. Primary lumbar hernias are extremely rare thereby rendering such a case reportable. Fifty computed tomography angiography of the upper abdomen m25, f25, mean age 72. A lumbar hernia following an iliac crest bone graft harvesting is a rare complication which is more frequent in females than males. Pitfalls and clinical recommendations for the primary. Presentation may be misleading and diagnosis often missed. Colonic incarceration through the inferior lumbar triangle, which causes mechanical obstructive symptoms, necessitates particular diagnostic and management strategy. The muscles are called the rectus muscles and the lateral obliques. Many surgeons are not familiar to lumbar hernias, which frequently leads to misdiagnosis and delay of treatment. 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.
Suggested by adrev masters admin sweet victory as featured in spongebob squarepants. Groin hernias are most commonly of the inguinal type but may also be femoral. The superior lumbar triangle, also known as the triangle of grynfelttlesshaft, is one of the locations for a lumbar hernia. Lumbar hernia is a rarely encountered posterior ventral hernia, 1 which accounts for 2016. Lumbar hernias are very infrequent posterior abdominal wall defects. It occurs anywhere between the 12 th rib and the iliac crest, and it can be congenital or acquired.
Lumbar hernias manifest through two possible defects in the posterior abdominal wall, the superior being more common. Superior lumbar hernia is more common than the inferior and it originates in the superior triangle. A lumbar hernia an uncommon type of abdominal hernia that develops in the lumbar region of the back. Primary lumbar hernias are extremely rare thereby rendering such a case reportable, to. A petit s lumbar hernia is, indeed, an extremely rare defect.
Most common in patients aged between 50 and 70 years with a male predominance 1. A lumbar hernia is best defined as a protrusion of either. To date, approximately 300 cases of lumbar hernia have been reported in the literature. Other hernias include hiatus, incisional, and umbilical hernias. 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.
May 23, 2016 lumbar hernias are protrusions of intraabdominal contents classically through the superior grynfeltt and inferior petit lumbar triangles. 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. Recently, a therapeutically aimed classification was proposed analysing the size, location, contents, muscular atrophy, origin, and existence of the previous recurrence. Management remains surgical with various techniques emerging over the years. A lumbar hernia is a rare pathological derangement of anatomy, especially when the postoperative type is excluded.
Oct 30, 2015 lumbar hernia is an uncommon abdominal wall hernia, making its diagnosis and management a challenge to the treating surgeon. Lumbar hernia is a relatively rare defect of the posterior abdominal wall, with approximately 300 cases reported in the literature. 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. 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. Classification, diagnosis and treatment are updated.
The neck of this hernia is usually large, and therefore, it has a lower risk of strangulation than other hernias 1. Laparoscopic lumbar hernia repair sages abstract archives. Looking to find a surgeon to repair it, it is a risky procedure and only 300 cases have ever been documented. A primary inferior lumbar hernia misdiagnosed as a lipoma. A lumbar hernia is a posterolateral body wall hernia where the bowel, omentum, or preperitoneal fat herniates through the lumbar triangles. Lumbar hernia is probably the most uncommon abdominal hernia type, with approximately 300 cases reported in the literature 1,2. Lumbar hernia account for less than 2% of al abdominal hernias, been the grynfeltlesshafts hernia glh more frequent than the others. An imaging study forms an indispensable aid in the diagnosis and surgery is the only treatment option. May 22, 2016 ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except groin hernias. Surgical repair is the only definitive treatment option through either an open or laparoscopic approach.
It herniates through the superior lumbar triangle grynfelttlesshaft triangle or inferior lumbar triangle petit triangle. Macchi v, porzionato a, morra a, picardi ee, stecco c, loukas m et al 2016 the triangles of grynfeltt and petit. Lumbar hernias occur in the region of the flank bounded by the 12th rib, the iliac crest, and the erector spinae and external oblique muscles. Lumbar hernias can be congenital or the result of injury or trauma to the back or abdomen. Petits hernia is a hernia that protrudes through the lumbar triangle.
It stems from a traumatic injury auto accident 10 yrs ago. The current management of lumbar hernias should reflect the development of modern imaging techniques and new forms of noninvasive treatment. Management of incidental lumboiliac hernia during spinal. Congenital hernias appear during infancy as the origin of a defect in the musculoskeletal system of the lumbar region, and are associated with other. Petit lumbar herniaa doublelayer technique for tension. Superior lumbar triangle radiology reference article. 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. Few studies exist to support a standard protocol for repair of these lateral hernias. The patient was free of recurrence at 4 months after. Petit later characterized the inferior lumbar triangle hernia in 1783 and grynfeltt the superior lumbar triangle hernia. Retrospective analysis of all patients of clh over a. They are bounded by the 12th rib, the iliac crest, the erector spinae, and the external oblique muscle.
Laparoscopic treatment of incisional lumbar hernia. 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. In most cases, multiple types of lumbar hernia were included in the study, and in four studies, the aetiology of the lumbar hernia was not specified beyond lumbar or acquired 8, 9, 11, 16. A petits lumbar hernia is, indeed, an extremely rare defect. Lumbar hernia is a rare abdominal wall defect and clinical suspicion is necessary for diagnosis. The anatomy of the triangles is variable and quantitative data are few. Lumbar herniation occurs through the petits or the grynfelttlesshaft triangles. 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. Awareness of the anatomical basis of this hernia is important for proper diagnosis and treatment. Sublay repair for primary superior lumbar hernia with the. Cureus management criteria of grynfeltts lumbar hernia. We report the case of a 40yearold caucasian woman with a superior lumbar hernia grynfeltt hernia initially misdiagnosed as a recurrent lipoma. Only 2 of the hernias were found in inferior triangle of petit.
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