Cureus management criteria of grynfeltts lumbar hernia. Petit s hernia is a hernia that protrudes through the lumbar triangle. Surgical repair is the only definitive treatment option through either an open or laparoscopic approach. Diagnosis isusuallyestablished bythepresence ofareducible softtissue massabovethe iliaccrest, which enlarges withthevalsalva maneuver or coughing. Two types are described, according to the anatomical location of the hernial neck. We present a rare case of inferior lumbar hernia, leading to mechanical bowel obstruction, successfully treated with. Subcutaneous lipoma was included in the differential diagnosis. A very simple technique to repair a superior lumbar hernia is described. Given their rarity and their nonspecific presentation, lumbar hernias are an easy diagnosis to overlook.
Lumbar hernias occur in a area of the back called the lumbar. Management of giant inferior triangle lumbar hernia petit s triangle hernia. 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. Lumbar hernias occur through defects in the lumbar muscles or the posterior fascia, below the 12 th rib and above the iliac crest. 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 hernias are a rare form of posterior abdominal hernia. Because of its rarity and nonspecific presentation, lumbar hernia often poses a diagnostic challenge, and it can be easily misdiagnosed as a lipoma. The location of this type of hernia, also known as the grynfelttlesshaft hernia, is defined by a triangle placed in the lumbar region. Management of incidental lumboiliac hernia during spinal.
Pdf management of giant inferior triangle lumbar hernia. A lumbar hernia an uncommon type of abdominal hernia that develops in the lumbar region of the back. 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. We describe a 70yearold woman presenting with large bowel obstruction secondary to incarceration of the mid descending colon within a lumbar hernia. 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. Up until 1946, watson 7 had collected 186 cases of lumbar hernia from the literature. Full text full text is available as a scanned copy of the original print version.
Recently, a therapeutically aimed classification was proposed analysing the size, location, contents, muscular atrophy, origin, and existence of the previous recurrence. Controversies in the current management of lumbar hernias. Get a printable copy pdf file of the complete article 876k, or click on a page image below to browse page by page. 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. Lumbar hernia is a relatively rare entity with only 300 cases described in the literature.
A 70yearold male with a reducible left sided superior lumbar hernia. If the processus vaginalis is not obliterated, fat or bowel may get into it. Lumbar hernias are rare defects involving two weak areas of the posterolateral wall that may be congenital or adquired. 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. We report the case of a 40yearold caucasian woman with a superior lumbar hernia grynfeltt hernia initially misdiagnosed as a recurrent lipoma. Diffuse lumbar hernias are most often iatrogenic kidney operations overlapping and imbricating suture mesh reinforcement repairs sciatic hernia. A lumbar hernia is a posterolateral body wall hernia where the bowel, omentum, or preperitoneal fat herniates through the lumbar triangles. Lumbar hernias occur through defects in the lumbar muscles or the posterior fascia, below the 12th rib and above the iliac crest. We present the case of a middleaged patient who presented with swelling in the left back. 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. After the descent of the foetal testis into the scrotum from the retroperitoneum, the processus vaginalis should obliterate 3. Abd wall hernias university of tennessee college of medicine. It stems from a traumatic injury auto accident 10 yrs ago. The neck the spot where the hernia protrudes into the opening is large, and therefore this hernia has a lower risk.
Many surgeons are not familiar to lumbar hernias, which frequently leads to misdiagnosis and delay of treatment. 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. Grynfelttleschaft hernia is a type of lumbar hernia occurring in the superior lumbar triangle. Garagngeot in 1731 and description of the anatomical limits of the inferior space was by petit 1783, and superior space was by grynfeltt 1866. An unusual case of a 67yearold woman with a superior lumbar hernia is reported. The neck of this hernia is usually large, and therefore, it has a lower risk of strangulation than other hernias 1. Such hernias may be difficult to diagnose on the basis of physical signs and. Types of abdominal wall hernia total hernia repair center. Clinical presentation patients with lumbar hernias can present with a variety of sym. Grynfeltts lumbar hernia is a rare abdominal wall pathology with around 300 cases described in the literature. Lumbar hernia surgery is performed laparoscopically, which means with a laparoscopic camera through a small incision. 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. Barbette, in 1672, first suggested the existence of a lumbar hernia. Surgery for a petit hernia starts with a slight cut on or below the navel belly button.
Petit lumbar herniaa doublelayer technique for tensionfree. Colonic incarceration through the inferior lumbar triangle, which causes mechanical obstructive symptoms, necessitates particular diagnostic and management strategy. Pathophysiology a hernia can be classified as reducible or irreducible. Lumbar hernia is the protrusion of intraperitoneal or extraperitoneal contents through a defect of the. Lumbar hernias are rare and diagnostically challenging for surgeons. It can be classified as congenital or acquired, which may be primary or secondary. 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. For example, in the case of an inguinal hernia, you may notice a lump on. What is the inferior lumbar triangle of petit relative to. Lumbar herniation occurs in the region of the flank bounded by the 12th rib. Grynfeltt and lesshaft independently described superior lumbar hernias in 1866 and 1870, respectively.
A very simple technique to repair grynfelttlesshaft hernia. They can occur in the triangle of grynfelt superior lumbar hernia and petit inferior lumbar hernia. The correct diagnosis was made intraoperatively and the hernia was repaired using synthetic mesh. Hernia lumbar hernia open repair prosthetic mesh repair d orsal or lumbar hernias are found in the. 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. As lumbar hernias are rarely discussed in literature, many orthopedists or radiologists do not suspect a hernia as the cause of low back pain. Grynfelt hernias are the most common and occurred in all patients of our series. It herniates through the superior lumbar triangle grynfelttlesshaft triangle or inferior lumbar triangle petit triangle. 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. 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. A lumbar hernia is a rare pathological derangement of anatomy, especially when the postoperative type is excluded. Theres a natural weak spot in the lower back called the superior lumbar triangle or grynfelttlesshaft triangle.
A case of strangulated hernia was described by petit in 1738, occurring through the inferior lumbar triangle, and this now bears his name. A rare complication following delayed breast reconstruction with extended latissimus dorsi myocutaneous flap. Abstract full text pdf 4597 kb pdf plus 1195 kb using ct to diagnose traumatic lumbar hernia karen l. A petit s lumbar hernia is, indeed, an extremely rare defect. It is named after french surgeon jean louis petit 16741750. Incarcerated inferior lumbar petits hernia springerlink.
In fact, this hernia occurs so infrequently that only an occasional surgeon has the opportunity of seeing and repairing one. Traumatic lumbar hernia tlh constitutes an uncommon acquired form of abdominal wall hernia. The superior lumbar triangle, also known as the triangle of grynfelttlesshaft, is one of the locations for a lumbar hernia. It was a case of primary acquired lumbar hernia in the superior lumbar triangle. Lumbar hernia misdiagnosed as a subcutaneous lipoma. Ct scan is considered to be the gold standard for the diagnosis and evaluation of the contents of lumbar hernia. We present a rare case of inferior lumbar hernia, leading to mechanical bowel obstruction, successfully treated with prosthetic mesh. 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. Backgroundobjetives lumbar hernias are rare sumamentes less than 1% and reported rarely. Incarcerated inferior lumbar petits hernia request pdf. This was diagnosed on barium enema and successfully treated surgically. Epidemiology most common in patients aged between 50 and 70 years with a male predominance 1.
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, 2003 petit s hernia is an uncommon abdominal wall defect in the inferior lumbar triangle. Links to pubmed are also available for selected references. Ct findings shigeru suzuki, shigeru furui, kota okinaga, tsutomu sakamoto, jun murata, akira furukawa, yasuo ohnaka american journal of roentgenology. The most common symptom of a hernia is a bulge or lump in the affected area. Petit s hernia is an uncommon abdominal wall defect in the inferior lumbar triangle. Pdf incarcerated inferior lumbar petits hernia sedat. The operational team then blows air into the abdomen to make space for the camera and surgical tools. The treatment of lumbar hernias should follow the concept of tensionfree surgery, and the preperitoneal space can be the best place for prosthesis placement. Lumbar hernias have been misdiagnosed as lipomas,, muscle strains, fibromas, abscesses, and kidney tumors, causing increased morbidity due to the incorrect diagnosis. 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.
Request pdf ambulatory laparoscopic repair of inferior lumbar or petit hernia lumbar hernias are an uncommon variety of abdominal wall defect. Lumbar hernia causes a lumbar hernia can be either a congenital condition or the result of trauma to the back or abdomen. 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. Of the two, the superior triangle is the more consistently found in cadavers, and is more commonly the site of herniation. However, in most cases, lumbar hernias are the result of old age. Suggested by adrev masters admin sweet victory as featured in spongebob squarepants. Inferior lumbar petit s hernia is an uncommon condition resulting from a defect in the posterior abdominal wall. This report describes an alternative technique for petit hernia repair. In 1750, ravaton pub lished the first report of a patient with. Lumbar hernia is one of the rare cases that most surgeons are not exposed to.
Case discussion the inferior lumbar triangle also known as petit triangle is an anatomical space through which inferior lumbar hernias can occur. Ambulatory laparoscopic repair of inferior lumbar or petit hernia. Dec 10, 2009 lumbar hernia is a rare abdominal wall defect and clinical suspicion is necessary for diagnosis. Lumbar hernia is the protrusion of intraperitoneal or extraperitoneal contents through a. Right inferior lumbar hernia petit hernia, with bowel protruding as content, defect measuring 4. This leads to delay in the treatment causing increased morbidity. Lumbar hernias areoftenasymptomatic, butmayproduce lowback pain,colic,orapullingsensation thatmayresolve withreduction ofthehernia. Following diagnostic studies, computed tomography confirmed left 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. We report a case of lumbar hernia in a middleaged woman.
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. Looking to find a surgeon to repair it, it is a risky procedure and only 300 cases have ever been documented. The current management of lumbar hernias should reflect the development of modern imaging techniques and new forms of noninvasive treatment. Extremely unusual hernias, difficult to diagnose, and the patient may be.
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