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Source publication
Introduction:
Posterior abdominal wall hernias are rare, mainly post traumatic or post-operative. This case is particular first by its mechanism, it is a primary lumbar hernia and secondly it is a concomitant hernia of the Jean Louis Petit triangle and the Grynfeltt triangle.
Presentation of case:
The patient was a 67 years old man, a former far...
Context in source publication
Context 1
... hernia sacs contained both of them the peritoneal fat and the small intestine (Fig. 3). The hernia sacs were refouled, a con- tinuous suture of the fascia transversalis was done with coated absorbable suture 2, the wall reinforcement with a porcine col- lagen mesh fixed on the quadratus lumborum and the internal oblique muscles, an interrupted suture for the latissimus muscle with a coated absorbable suture 2. A layered closure was done with absorbable thread and an interrupted suture with a non-absorbable suture thread for the skin (Fig. ...
Citations
... The preferred treatment of a lumbar hernia is an open prosthetic mesh repair, but laparoscopic mesh repair is being increasingly considered [8]. The only pitfall is that parietal peritoneal closure cannot be done using a laparoscopic approach [1,6,9,10]. Primary repair of the defect is not preferred as it has tension [11], with high chances of recurrence. ...
Lumbar hernia is an uncommon condition that can either be congenital or acquired. Acquired lumbar hernia is further divided into primary, with no identifiable cause, and secondary, occurring due to previous trauma, infection, or surgery. Here, we present the case of inferior lumbar hernia in a 65-year-old Asian male who was a chronic alcoholic and smoker. He presented with a complaint of a longstanding swelling in the right lumbar region for five years and no other associated symptoms. The swelling was reducible, an expansile cough impulse was felt on palpation, and bowel sounds were heard on auscultation. A contrast-enhanced computed tomography scan revealed a 6.7 cm defect in the lateral abdominal wall in the right lumbar region with bowel loops, cecum, ascending colon, mesentery, and mesenteric artery seen herniating through the defect. There was a history of an iliopsoas abscess at the same site five years ago, which was treated with incision and drainage. The patient was advised for an open mesh repair but could not be operated upon due to coexisting aortic stenosis and regurgitation. Our impression, from this report, is that a chronic iliopsoas abscess tracking to the inferior lumbar region and the incision and drainage thereof, leading to a weakness in the abdominal wall, may be considered to be a cause of inferior lumbar hernia, with chronic smoking on part of the patient being a significant contributing factor for the abdominal muscle weakness. Therefore prompt and meticulous treatment of an iliopsoas abscess must be done to prevent this complication.
... There is no real consensus about the best method of repairing a LH due to its low incidence. (8) Synthetic meshplasty is the most used among open repairs combined with muscle flaps, (7) this case only required the use of synthetic meshplasty for repairing the defect as there were no others issues such as a herniated sac with abdominal organs in its interior or a bigger ring that needed muscle flaps. ...
Introduction:
Lumbar hernia (LH) is rarely found in teenager patients. There is an increased incidence of traumatic etiology of LH related to new diagnostic methods. LH has been frequently misdiagnosed as other surgical entities. A case of acquired primary superior lumbar hernia in a teenager patient with no previous history of surgical diseases is presented.
Objective:
To specify the keys for the diagnosis of acquired Grynfeltt-Lesshaft hernia in a teenager patient.
Case Presentation:
A 14-year-old African-American male patient who complained of an occasionally painful swelling over the left side of the lumbar region was clinically diagnosed with a Grynfelt-Lesshaft hernia which was confirmed by CT scan. The patient was operated on with a transverse incision over the tumour for the lumpectomy. The contents were reduced, and the 1cm x 1cm ring with no sac was closed and reinforced with a polyester fibre prosthetic mesh. No immediate complications were observed. The patient was discharged from the health care center five days after the procedure.
Conclusions:
The Grynfelt-Lesshaft hernia is an uncommon surgical condition related to a congenital or acquired etiology. The available advances in the diagnostic methods allow us to easily identify a Grynfelt-Lesshaft hernia in younger patients.
Introduction
Lumbar hernias are rare, with only 200–300 published cases listed in the literature. Two areas are described to have weakness points: the inferior lumbar triangle (Jean-Louis Petit triangle) and the superior lumbar triangle (Grynfeltt–Lesshaft triangle). Clinical diagnosis is confirmed by computed tomography and possibly by ultrasound or radiography. The surgeon must refine the clinical detection of this condition, as most patients do not have sufficient means to have a computed tomography scan performed, which remains the gold standard for diagnosis. Despite the different techniques recommended, the open route remains the most affordable in our environment.
Case presentation
This case presents an 84-year-old black congolese patient consulted for bilateral swellings of the lumbar regions. The patient was married and in the farming profession for several years. The patient had no notion of trauma or fever and no notion of vomiting or stopping of materials and gases. The lumbar region presented with swellings that were ovoid, soft, painless, impulsive and expansive on coughing or hyperpressure, and non-pulsatile, measuring 9 × 7 cm in diameter (right) and 6 × 5 cm in diameter (left). Ultrasound performed of the upper costolumbal region revealed two lipomatous masses facing Grynfeltt’s quadrilateral with a 1.5 cm hole on either side. The diagnosis of bilateral Grynfeltt hernia was made, and herniorrhaphy was indicated.
Conclusion
Grynfeltt–Lesshaft hernia is a rare surgical condition caused by congenital or acquired etiology. A lower back pain or a pain point localized on the hernia in addition to a lumbar mass that reduces when lying down suggests the diagnosis of lumbar hernia.
Hernia of the Jean Louis Petit triangle and hernia of Grynfeltt's quadrilateral space can be classified as lumbar hernias. Its clinical diagnosis is confirmed by computed tomography and, possibly, by ultrasound or x-ray. There is a formal indication for surgery including swelling or functional discomfort but, above all, the risk of strangulation. We here report a rare case of recurrence of primary hernia of the Jean Louis Petit triangle in a 65-year old man.
© Nathalie Dinganga Kapessa et al.
