A petit s lumbar hernia is, indeed, an extremely rare defect. We report a case of lumbar hernia in a middleaged woman. Following diagnostic studies, computed tomography confirmed left lumbar hernia. Grynfeltt hernia is described as herniation of retroperitoneal fat through the aponeurosis of the transversalis muscle between the erector spinae muscles and internal oblique muscles in the superior lumbar triangle. A 70yearold male with a reducible left sided superior lumbar hernia. It was a case of primary acquired lumbar hernia in the superior lumbar triangle. Clinical presentation patients with lumbar hernias can present with a variety of sym. Lumbar hernia misdiagnosed as a subcutaneous lipoma.
Types of abdominal wall hernia total hernia repair center. We present a rare case of inferior lumbar hernia, leading to mechanical bowel obstruction, successfully treated with. Lumbar hernia is the protrusion of intraperitoneal or extraperitoneal contents through a. Grynfeltts lumbar hernia is a rare abdominal wall pathology with around 300 cases described in the literature. Recently, a therapeutically aimed classification was proposed analysing the size, location, contents, muscular atrophy, origin, and existence of the previous recurrence. Hernia lumbar hernia open repair prosthetic mesh repair d orsal or lumbar hernias are found in the. What is the inferior lumbar triangle of petit relative to. It is named after french surgeon jean louis petit 16741750. Incarcerated inferior lumbar petits hernia springerlink. Grynfeltt and lesshaft independently described superior lumbar hernias in 1866 and 1870, respectively. A very simple technique to repair a superior lumbar hernia is described.
Apr 28, 2015 symptoms, risk factors and treatments of petits hernia medical condition petits hernia is a hernia that protrudes through the lumbar triangle this video contains general medical information if. Ct scan is considered to be the gold standard for the diagnosis and evaluation of the contents of lumbar hernia. Epidemiology most common in patients aged between 50 and 70 years with a male predominance 1. A case of strangulated hernia was described by petit in 1738, occurring through the inferior lumbar triangle, and this now bears his name. Management of incidental lumboiliac hernia during spinal. Abd wall hernias university of tennessee college of medicine. Many surgeons are not familiar to lumbar hernias, which frequently leads to misdiagnosis and delay of treatment. Case discussion the inferior lumbar triangle also known as petit triangle is an anatomical space through which inferior lumbar hernias can occur. Petit s hernia is an uncommon abdominal wall defect in the inferior lumbar triangle. This leads to delay in the treatment causing increased morbidity.
Ct findings shigeru suzuki, shigeru furui, kota okinaga, tsutomu sakamoto, jun murata, akira furukawa, yasuo ohnaka american journal of roentgenology. Lumbar hernias are a rare form of posterior abdominal hernia. Of the two, the superior triangle is the more consistently found in cadavers, and is more commonly the site of herniation. Backgroundobjetives lumbar hernias are rare sumamentes less than 1% and reported rarely. Given their rarity and their nonspecific presentation, lumbar hernias are an easy diagnosis to overlook. Garagngeot in 1731 and description of the anatomical limits of the inferior space was by petit 1783, and superior space was by grynfeltt 1866. We present the case of a middleaged patient who presented with swelling in the left back.
This report describes an alternative technique for petit hernia repair. Up until 1946, watson 7 had collected 186 cases of lumbar hernia from the literature. Theres a natural weak spot in the lower back called the superior lumbar triangle or grynfelttlesshaft triangle. In 1750, ravaton pub lished the first report of a patient with. Cureus management criteria of grynfeltts lumbar hernia. Pain patterns in lumbar disc hernia drawings compared to surgical findings in 159 patients harald brismar, nikola vucetic and olle svensson we compared preoperative paindrawing patterns of 159 patients with findings at lumbar disc surgery. Petit lumbar herniaa doublelayer technique for tensionfree. It stems from a traumatic injury auto accident 10 yrs ago. Lumbar hernia surgery is performed laparoscopically, which means with a laparoscopic camera through a small incision.
Grynfelt hernias are the most common and occurred in all patients of our series. The neck of this hernia is usually large, and therefore, it has a lower risk of strangulation than other hernias 1. Incidence in 1902, vonbaracz reported 68 records of true lumbar hernias which he found in the world literature, but only 3 of these stated the exact anatomic location. Lumbar herniation occurs in the region of the flank bounded by the 12th rib. A very simple technique to repair grynfelttlesshaft hernia. Lumbar hernias occur through defects in the lumbar muscles or the posterior fascia, below the 12 th rib and above the iliac crest. Pdf management of giant inferior triangle lumbar hernia. However, in most cases, lumbar hernias are the result of old age. This was diagnosed on barium enema and successfully treated surgically. Management of giant inferior triangle lumbar hernia petit s triangle hernia. The operational team then blows air into the abdomen to make space for the camera and surgical tools. Surgery for a petit hernia starts with a slight cut on or below the navel belly button. Incarcerated inferior lumbar petits hernia request pdf.
Subcutaneous lipoma was included in the differential diagnosis. It can be classified as congenital or acquired, which may be primary or secondary. Extremely unusual hernias, difficult to diagnose, and the patient may be. Petit s 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.
Full text full text is available as a scanned copy of the original print version. As lumbar hernias are rarely discussed in literature, many orthopedists or radiologists do not suspect a hernia as the cause of low back pain. Lumbar hernia is the protrusion of intraperitoneal or extraperitoneal contents through a defect of the. 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. Lumbar hernias are rare and diagnostically challenging for surgeons. The lumbar triangle can refer to either the inferior lumbar petit triangle, which lies superficially, or the superior lumbar grynfeltt triangle, which is deep and superior to the inferior triangle. In fact, this hernia occurs so infrequently that only an occasional surgeon has the opportunity of seeing and repairing one. Right inferior lumbar hernia petit hernia, with bowel protruding as content, defect measuring 4. Petit s hernia is a hernia that protrudes through the lumbar triangle. If the processus vaginalis is not obliterated, fat or bowel may get into it. A lumbar hernia is a posterolateral body wall hernia where the bowel, omentum, or preperitoneal fat herniates through the lumbar triangles. Pathophysiology a hernia can be classified as reducible or irreducible.
A lumbar hernia is a rare pathological derangement of anatomy, especially when the postoperative type is excluded. Lumbar hernias occur through defects in the lumbar muscles or the posterior fascia, below the 12th rib and above the iliac crest. Controversies in the current management of lumbar hernias. Dec 10, 2009 lumbar hernia is a rare abdominal wall defect and clinical suspicion is necessary for diagnosis. Lumbar hernias are rare defects involving two weak areas of the posterolateral wall that may be congenital or adquired. For example, in the case of an inguinal hernia, you may notice a lump on. Barbette, in 1672, first suggested the existence of a lumbar hernia. Surgical repair is the only definitive treatment option through either an open or laparoscopic approach.
Neither the grynfelttlesshaft hernia of the superior lumbar triangle nor the petit hernia of the inferior lumbar triangle is the first diagnosis that comes to mind when a patient presents with a back mass. It herniates through the superior lumbar triangle grynfelttlesshaft triangle or inferior lumbar triangle petit triangle. The first authentic case was observed and recorded in 1731, by degarengeot. The most common site for the occurrence of lumbar hernias is in the superior lumbar triangle grynfeltt and less commonly in the inferior lumbar triangle petit. Get a printable copy pdf file of the complete article 876k, or click on a page image below to browse page by page. The patient was free of recurrence at 4 months after. Request pdf ambulatory laparoscopic repair of inferior lumbar or petit hernia lumbar hernias are an uncommon variety of abdominal wall defect. The most common symptom of a hernia is a bulge or lump in the affected area. The inferior lumbar triangle of petit is bounded posteriorly by the latissimus dorsi, anteriorly by the external oblique muscle, and inferiorly by the iliac crest.
Petit lumbar herniaa doublelayer technique for tension. The location of this type of hernia, also known as the grynfelttlesshaft hernia, is defined by a triangle placed in the lumbar region. Colonic incarceration through the inferior lumbar triangle, which causes mechanical obstructive symptoms, necessitates particular diagnostic and management strategy. 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. Grynfelttleschaft hernia is a type of lumbar hernia occurring in the superior lumbar triangle. Because of its rarity and nonspecific presentation, lumbar hernia often poses a diagnostic challenge, and it can be easily misdiagnosed as a lipoma. Los altos porcentajes de incarceracion y estrangulacion se dan en especial para las hernias de grynfeltt y petit por tener orificios relativamente pequenos y en las hernias incisionales multioperadas por tener anillos. Lumbar hernia is a relatively rare entity with only 300 cases described in the literature. They can occur in the triangle of grynfelt superior lumbar hernia and petit inferior lumbar hernia. Ambulatory laparoscopic repair of inferior lumbar or petit hernia. Superior lumbar triangle radiology reference article.
Diffuse lumbar hernias are most often iatrogenic kidney operations overlapping and imbricating suture mesh reinforcement repairs sciatic hernia. Such hernias may be difficult to diagnose on the basis of physical signs and. A lumbar hernia an uncommon type of abdominal hernia that develops in the lumbar region of the back. The current management of lumbar hernias should reflect the development of modern imaging techniques and new forms of noninvasive treatment. In larger defects, a second mesh can be used to prevent further enlargement of the triangle and also to provide additional protection beyond the bone limits. Diagnosis isusuallyestablished bythepresence ofareducible softtissue massabovethe iliaccrest, which enlarges withthevalsalva maneuver or coughing. Several medical experts state that a lumbar hernia develops over time due to a weakness of the abdomen wall and loss of muscle and fatty tissue. Two types are described, according to the anatomical location of the hernial neck. A rare complication following delayed breast reconstruction with extended latissimus dorsi myocutaneous flap.
Suggested by adrev masters admin sweet victory as featured in spongebob squarepants. When an abdominal hernia develops toward the back of the abdomen wall, it may bulge through one of the lumbar triangles in the back, causing a lumbar hernia. Traumatic lumbar hernia tlh constitutes an uncommon acquired form of abdominal wall hernia. Links to pubmed are also available for selected references. Superior lumbar grynfelttlesshaft triangle edit the superior lumbar grynfelttlesshaft triangle is formed medially by the quadratus lumborum, laterally by the posterior border of internal abdominal oblique muscle, and superiorly by the 12th rib. We present a rare case of inferior lumbar hernia, leading to mechanical bowel obstruction, successfully treated with prosthetic mesh. We report the case of a 40yearold caucasian woman with a superior lumbar hernia grynfeltt hernia initially misdiagnosed as a recurrent lipoma. An unusual case of a 67yearold woman with a superior lumbar hernia is reported. After the descent of the foetal testis into the scrotum from the retroperitoneum, the processus vaginalis should obliterate 3. Looking to find a surgeon to repair it, it is a risky procedure and only 300 cases have ever been documented. Abstract full text pdf 4597 kb pdf plus 1195 kb using ct to diagnose traumatic lumbar hernia karen l. Apr 10, 2003 petit s hernia is an uncommon abdominal wall defect in the inferior lumbar triangle. In this lecture, dr dumanian demonstrates the repair of incisional flank hernias using either well fixed narrow meshes, or else with a mesh sutured technique.
Lumbar hernia is one of the rare cases that most surgeons are not exposed to. We describe a 70yearold woman presenting with large bowel obstruction secondary to incarceration of the mid descending colon within a lumbar hernia. 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. Lumbar hernias lumbar hernias occur through defects in the lumbar muscles or the posterior fascia, below the 12th rib and above the iliac crest. The neck the spot where the hernia protrudes into the opening is large, and therefore this hernia has a lower risk. Inferior lumbar petit s hernia is an uncommon condition resulting from a defect in the posterior abdominal wall. Lumbar hernias are rare and on the basis of etiology are classified into congenital or acquired, representing 20% and 80% of cases, respectively. Apr 10, 2020 the inferior lumbar triangle of petit is bounded posteriorly by the latissimus dorsi, anteriorly by the external oblique muscle, and inferiorly by the iliac crest. Lumbar hernia causes a lumbar hernia can be either a congenital condition or the result of trauma to the back or abdomen. Lumbar hernias are rare lesions that are usually observed after trauma or surgery.
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