The treatment of lumbar hernias should follow the concept of tensionfree surgery, and the preperitoneal space can be the best place for prosthesis placement. Pdf abstract this report describes an alternative technique for petit hernia repair. The correct diagnosis was made intraoperatively and the hernia was repaired using synthetic mesh. Given their rarity and their nonspecific presentation, lumbar hernias are an easy diagnosis to overlook. Indirect inguinal hernia an indirect inguinal hernia occurs when any intraabdominal structure protrudes through the deep inguinal ring entering the inguinal canal. The current management of lumbar hernias should reflect the development of modern imaging techniques and new forms of noninvasive treatment. The antimesenteric border of the intestine must protrude into the hernia sac the most common location is at the site of a femoral hernia. Petit described the inferior lumbar triangle in 1783 and grynfeltt described the superior lumbar triangle in 1866. Lumbar disc herniation, a therapeutic vision une vision. Petit lumbar herniaa doublelayer technique for tensionfree. 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. Petit lumbar herniaa doublelayer technique for tension. Lumbar hernia grynfeltt mesh abstract lumbar hernias are rare defects involving two weak areas of the posterolateral wall that may be congenital or adquired.
Diagnosis depends largely on the capacity for clinical suspicion, and confirmation is based on imaging tests. 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. A petit s lumbar hernia is, indeed, an extremely rare defect. Definition protrusion of a viscus through an opening in the wall of the cavity in which it is contained the size of a hernia is determined by the dimension of the neck and the volume of the distended sac reducible incarcerated when the protruded viscus can be returned to the abdomen. Meckel diverticulum as the sole component of the hernia sac. The treatment of lumbar hernias should follow the concept of. Of the two, the superior triangle is the more consistently found in cadavers, and is more commonly the site of herniation. Hernia lumbar hernia open repair prosthetic mesh repair d orsal or lumbar hernias are found in the. 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. Petit lumbar hernia a doublelayer technique for tensionfree repair. A lumbar hernia is a rare pathological derangement of anatomy, especially when the postoperative type is excluded. Pdf petit lumbar herniaa doublelayer technique for tension. We report a case of lumbar hernia in a middleaged woman. We present a case of traumatic lumbar hernia in the petit triangle.
Petit s hernia is a hernia that protrudes through the lumbar triangle. 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. Encarceramento e estrangulamento ocorrem em 10% dos casos. The treatment of lumbar hernias should follow the concept of tensionfree surgery, and the preperitoneal. Definition hernia meansto bud or to protrude off shoot greek rupture latin hernia is defined as an abnormal protrusion of a viscous or a part of a viscous through an opening, artificial or natural with a sac, covering it. In 1750, ravaton pub lished the first report of a patient with strangulated lumbar hernia who survived operation. An indirect inguinal hernia is a congenital lesion. The treatment of lumbar hernias should follow the concept of tensionfree surgery, and the. Lumbar hernia is the protrusion of intraperitoneal or extraperitoneal contents through a defect of the abdominal wall.
We report on the use of a biosynthetic mesh as an adjunct to repairing a traumatic lumbar hernia, which has a higher likelihood of contamination or infection secondary to traumatic etiology. Controversies in the current management of lumbar hernias. Theres a natural weak spot in the lower back called the superior lumbar triangle or grynfelttlesshaft triangle. Lumbar hernias are a protrusion of intraabdominal contents through a weakness or rupture in the posterior abdominal wall. Different surgical techniques to repair these hernias have been described. Lumbar hernia is the protrusion of intraperitoneal or extraperitoneal contents through a. Petit lumbar hernia a doublelayer technique for tension. Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except groin hernias. Repair of a traumatic lumbar hernia with biosynthetic mesh. It was a case of primary acquired lumbar hernia in the superior lumbar triangle. Traite des maladies chirurgicales, et des operations qui leur convenient. Petits hernia is a hernia that protrudes through the lumbar triangle. We report the case of a 40yearold caucasian woman with a superior lumbar hernia grynfeltt hernia initially misdiagnosed as a recurrent lipoma. Request pdf incarcerated inferior lumbar petit s hernia petits hernia is an uncommon abdominal wall defect in the inferior lumbar triangle.
Clinical presentation patients with lumbar hernias can present with a variety of sym. Pdf lumbar hernias are rare and diagnostically challenging for. Lumbar hernias are an uncommon variety of abdominal wall defect. Lumbar hernia is one of the rare cases that most surgeons are not exposed to. Petit lumbar herniaa doublelayer technique for tensionfree repair. Traite des maladies chirurgicales, et des operations qui leur. Get a printable copy pdf file of the complete article 876k, or click on a page image below to browse page by page. This leads to delay in the treatment causing increased morbidity. The neck the spot where the hernia protrudes into the opening is large, and therefore this hernia has a lower risk of. 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 arise through posterolateral abdominal wall defects, named inferior triangle. The superior lumbar triangle is bordered by the internal oblique muscle anteriorly, the 12th rib superiorly, and the erector spinal muscle posteriorly. Imaging features, complications, and diagnostic pitfalls at multi.
The anatomy of the posterior abdominal wall with its two triangles, inferior of petit and superior of grynfelt lesshaft is presented. They are considered to be a rare entity with approximately 300 cases reported in the literature since it was first described by barbette in 1672. Backgroundobjetives lumbar hernias are rare sumamentes less than 1% and reported rarely. Links to pubmed are also available for selected references. Lumbar hernias are a rare form of posterior abdominal hernia.
Ambulatory laparoscopic repair of inferior lumbar or petit. In fact, this hernia occurs so infrequently that only an occasional surgeon has the opportunity of seeing and repairing one. Lumbar hernias are rare lesions that are usually observed after trauma or surgery. Critical to the repair of richters hernia is an adequate evaluation of the intestine for viability. Full text full text is available as a scanned copy of the original print version. 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. 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. This report describes an alternative technique for petit hernia. Lumbar hernia is defined as the presence of failure in the transverse fascia or in the aponeurosis of the transverse abdominal muscle that results in the extrusion of intra or extra peritoneal organs through the discontinuity of the postero lateral abdominal wall. Lumbar hernias lumbar hernias occur through defects in the lumbar muscles or the posterior fascia, below the 12th rib and above the iliac crest. A case of strangulated hernia was described by petit in 1738, occurring through the inferior lumbar triangle, and this now bears his name. Surgical treatment is controversial due to difficulty in defining the borders of the lumbar defect and the involvement of a bone margin. Incarcerated inferior lumbar petits hernia request pdf. This report describes an alternative technique for petit hernia repair.