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