Case presentation we report the case of a 40yearold caucasian woman with a superior lumbar hernia grynfeltt hernia initially misdiagnosed as a recurrent lipoma. The treatment of lumbar hernias should follow the concept of tensionfree surgery, and the. Lumbar hernias can be congenital or primary, occurring in the inferior lumbar triangle or petit type or in the superior lumbar. Sep 01, 2014 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. Herniation can occur either through defects in the lumbar muscles or the posterior fascia transversalis or lumbodorsal in the superior grynfelttlesshaft or inferior petit s lumbar triangles. Lumbar hernia surgery is performed laparoscopically, which means with a laparoscopic camera through a small incision. We present the case of a middleaged patient who presented with swelling in the left back.
Singleincision laparoscopic total extraperitoneal repair. The aim of our study was to identify and describe variations in the size and anatomy of the tg. The treatment of lumbar hernias should follow the concept. Barbette was the first, in 1672, to suggest the existence of lumbar hernias. The correct diagnosis was made intraoperatively and the hernia was repaired using synthetic mesh. 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. The inferior lumbar triangle, also known as the petit triangle, is an anatomical space through which inferior lumbar hernias can occur. It is named after french surgeon jean louis petit 16741750.
This triangle lies in the posterolateral abdominal wall and is bounded. 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. Conflict of interests e authors declare that there is no con ict of interests regarding the publication of this paper. Subsequently they describe the diagnostics aspects and the. Surgical treatment is controversial due to difficulty in defining the borders of the lumbar defect and the involvement of a bone margin. Lumbar hernias develop through the weakening of the posterolateral abdominal wall associated with the petits triangle or the grynfelttlesshaft triangle.
Superior lumbar hernia is more common than the inferior and it originates in the superior triangle. Rest of the grynfeltts lesshaft hernia presenting through superior systemic examination was within normal limits. We successfully repaired a lumbar hernia using a singleincision laparoscopic total. In our case, we decided to approach the lumbar hernia via the transabdominal approach. Nov 20, 2019 a lumbar hernia is a rare type of hernia that develops as a result of symptoms like over back pain, etc. Pdf spigelian hernia associated with strangulation of. They 1 occur between the 12th rib and the iliac crest 2. It can be congenital or acquired, primary or secondary, peritoneal or extraperitoneal, reducible or complicated. Both open and laparoscopic are accepted approaches, and each has advantages and disadvantages.
Lillie gr, deppert e 2010 inferior lumbar triangle hernia as a rarely reported cause of low back pain. The risk of incarceration and strangulation is very low. 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. Pdf petit lumbar herniaa doublelayer technique for tension. Singleincision laparoscopic total extraperitoneal repair for. It is not to be confused with the adjacent superior lumbar triangle of grynfelttlesshaft. What is the inferior lumbar triangle of petit relative to.
Bilateral lumbar hernias a case report and an overview of. A 70yearold male with a reducible left sided superior lumbar hernia. Femoral hernias are much less common than inguinal hernias and mainly affect older women. Congenital hernias in the lumbar region are a rarity. Lumbar hernia, a rare cause of intestinal occlusion. Lumbar hernia of petit seen at lagos university teaching. Incarcerated inferior lumbar petits hernia request pdf. Pdf abstract this report describes an alternative technique for petit hernia repair. Controversies in the current management of lumbar hernias. Ambulatory laparoscopic repair of inferior lumbar or petit. Backgroundobjetives lumbar hernias are rare sumamentes less than 1% and reported rarely. Diagnosis isusuallyestablished bythepresence ofareducible softtissue massabovethe iliaccrest, which enlarges withthevalsalva maneuver or coughing. Lumbar hernia is a relatively rare entity with only 300 cases described in the literature. It herniates through the superior lumbar triangle grynfelttlesshaft triangle or inferior lumbar triangle petit triangle.
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. Karademir incarcerated inferior lumbar petit s hernia received. Dorsal lumbar hernias are rare pathologies of the abdominal wall. Dec 10, 2009 introduction lumbar hernia is a rare abdominal wall defect and clinical suspicion is necessary for diagnosis. Petit lumbar herniaa doublelayer technique for tensionfree. The authors are surgeons of moscati hospital in aversa ceitaly, and one of them is a radiologist in the same hospital. Petits hernia is a hernia that protrudes through the lumbar triangle aka petits triangle. Lumbar hernia is the protrusion of intraperitoneal or extraperitoneal contents through. Lumbar hernia is one of the rare cases that most surgeons are not exposed to. We present a case of traumatic lumbar hernia in the petit triangle, diagnosed by. A superior lumbar hernia, which is also known as a grynfeltt hernia, is a rare abdominal wall defect that can be primary or secondary to trauma or orthopedic surgery. 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 case of a man with an incarcerated spontaneous petit s hernia who required urgent surgical intervention and mesh repair is presented. Incarcerated small bowel within a spontaneous lumbar hernia. The triangle was studied in 50 adult human cadavers, and dimensions and surface area were measured. The clinical anatomy of the triangle of grynfeltt hernia.
The current management of lumbar hernias should reflect the development of modern imaging techniques and new forms of noninvasive treatment. Lumbar hernias are a rare pathology of the posterior abdominal wall. Congenital lumbar hernia with lumbocostovertebral syndrome. Pdf spigelian hernia associated with strangulation of the. Jan 01, 20 lumbar hernia is a rare condition with fewer than 300 cases reported in the literature. Introduction lumbar hernias lh are defects of the posterolateral abdominal wall. The inferior lumbar triangle of petit, bounded by iliac crest, posterior border of external oblique and the anterior border of latissimus dorsi is the next most frequent site. Fatty tissue or part of the intestine pushes through the abdomen near the navel belly button. Publication types case reports mesh terms adult aged. One patient had a traumatic hernia through the superior lumbar grynfelttlesshaft triangle, which is an in.
Garagngeot in 1731 and description of the anatomical limits of the inferior space was by petit 1783, and superior space was by grynfeltt 1866. It can be classified as congenital or acquired, which may be primary or secondary. Any information contained in this pdf file is automatically generated from. These involve the ribs, spine, muscles, kidneys, and spinal meninges. The four borders of grynfeltt or superior lumbar hernia are the 12th rib superiorly, quadratus lumborum muscle medially, iliac crest inferiorly, and internal oblique. A commonly misevaluated condition of the bilateral. Clinicians are generally unfamiliar with the presentation of lumbar hernias, which frequently leads to misdiagnosis and delay of treatment. Lumbar hernias of the posterolateral abdominal wall netkey. Petit lumbar herniaa doublelayer technique for tension. 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. Fatty tissue or part of the intestine protrudes into the groin at the top of the inner thigh. Nov 01, 2005 lumbar hernias occur through defects in the lumbar muscles or the posterior fascia, below the 12th rib and above the iliac crest.
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 a hernia that protrudes through the lumbar triangle aka petit s triangle. Herniation may occur through the superior grynflettlesshaft, fig 5 or, less commonly, the inferior petit lumbar triangle. Following diagnostic studies, computed tomography confirmed left lumbar hernia. They account for only 10% of all the lumbar hernias. Lumbar hernias are an uncommon variety of abdominal wall defect.
Management of incidental lumboiliac hernia during spinal cord. This leads to delay in the treatment causing increased morbidity. Diagnosis depends largely on the capacity for clinical suspicion, and confirmation is based on imaging tests. It arises through posterolateral abdominal wall defects, named the inferior triangle petit and superior triangle grynfelt. Congenital lumbar hernia is associated with a multitude of congenital anomalies involving various other organ systems of the body. Lumbar hernias occur spontaneously, postsurgically or secondary to trauma, especially after pelvic fracture. Lumbar hernias are rare and diagnostically challenging for surgeons. It is therefore generally agreed that lumbar hernias should be repaired early 19. A lumbar hernia is a rare type of abdominal wall defect over the lumbar triangles that can be categorized into superior grynfeltt and inferior petit by anatomic location. Most lumbar hernias increase in size with time, and overall, there is a 25% risk of incarceration and 8% rate of strangulation. We report a case of lumbar hernia in a middleaged woman. 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. Ambulatory laparoscopic repair of inferior lumbar or petit hernia. Request pdf incarcerated inferior lumbar petit s hernia petit s hernia is an uncommon abdominal wall defect in the inferior lumbar triangle.
This is the most common type of hernias and occurs in the groin region above. It was a case of primary acquired lumbar hernia in the superior lumbar triangle. Twenty percent of lumbar hernias are congenital and the other 80% are acquired. This report describes an alternative technique for petit hernia repair. This is an entity suggested since 1672 by bardett and only 250 to 300 cases have been described in the english literature until 1995 2 3 4 5. Fixing an inferior lumbar hernia is a complicated surgery. Inferior lumbar triangle radiology reference article. Pitfalls and clinical recommendations for the primary lumbar hernia. A petit s lumbar hernia is, indeed, an extremely rare defect. Underlay mesh repair for spontaneous lumbar hernia. Lumbar hernias areoftenasymptomatic, butmayproduce lowback pain,colic,orapullingsensation thatmayresolve withreduction ofthehernia. The anatomic location of a lumbar hernia makes diagnosis and repair challenging. Subcutaneous lipoma was included in the differential diagnosis.
Lumbar hernia misdiagnosed as a subcutaneous lipoma. Case report open access singleincision laparoscopic total. Elective surgery was performed, and the results revealed petits. There are so many muscles and vital organs to work around and trying to establish a foundation for muscleonmuscle tears is challenging. Subsequently they describe the diagnostics aspects and then the surgicals treatments. Lumbar hernia of petit seen at lagos university teaching hospital west afr med j niger med dent pract. Such hernias may manifest within the superior lumbar triangle of grynfeltt tg or the triangle of petit.
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