The sac that bulges through the weak area may contain a piece of intestine or fatty lining of the colon omentum if the hernia occurs in the abdominal wall or groin. The miami hernia center located in miami beach, florida is dedicated to the evaluation, diagnosis, management and treatment of all types of abdominal wall hernias, including inguinal groin, umbilical belly button, ventral, incisional after a previous surgery, epigastric, femoral, recurrent and complex abdominal wall reconstructions. Abdominal wall hernias are typically classified by location or etiology. Groin hernias are most commonly of the inguinal type but may also be femoral. Theres a natural weak spot in the lower back called the superior lumbar triangle or grynfelttlesshaft triangle. A lumbar hernia is the protrusion of intraperitoneal or extraperitoneal contents through a defect of the posterolateral abdominal wall figure 4. Discussion lumbar hernias are very rare and probably one of the lesserknown hernias occurring through the posterior abdominal wall, in the lumbar space 1. Lumbar herniation occurs in the region of the flank bounded by the 12th rib, the iliac crest and the erector spinae and external oblique muscle groups. Furthermore, it can be helpful in the assessment of symptomatic patients after flank incision, to differentiate postincisional muscular weakness and intercostal neuralgia from a. While this hernia may initially present as a small asymptomatic bulge, the defect typically enlarges over time and can become symptomatic with potentially serious complications. Lumbar hernias occur through a parietal wall defect in the lumbar region whose boundaries are the 12th rib superiorly, the iliac crest inferiorly, the erector spinae muscle medially, and the posterior border of the external abdominal oblique laterally.
Grynfelttleschaft hernia is a type of lumbar hernia occurring in the superior lumbar triangle. The abdominal wall consists of four paired muscles that span the area between the ribs and pelvis. The best treatment for bothersome abdominal hernias is an operation to push back the protruding organ or tissue into the abdomen and reinforce the weakened muscles. A lumbar hernia may be suspected when a spigelian hernia loop moves to the lumbar region or to the lateral side of the abdominal wall. For example, the intestines may break through a weakened area in the abdominal wall.
The abdominal wall the structure of the abdominal wall is similar in principle to the thoracic wall. The transversus abdomins is the deepest of these and attaches from lower ribs, to the inguinal ligament and iliac crest and the lumbar vertebrae, and reduces the diameter of the abdomen on. Lumbar hernias are quite rare, constituting 2% of all abdominal wall hernias, and they are usually secondary to trauma or previous surgery. The correct diagnosis was made intraoperatively and the hernia was repaired using synthetic mesh. Abdominal wall hernia an overview sciencedirect topics. An internal hernia is among the most challenging abdominal hernia diagnoses on ct. This page includes the following topics and synonyms.
Lumps and bumps of the abdominal wall and lumbar region. Lumbar hernia should be suspected in patients with highenergy injuries of the torso, and all. A hernia occurs when an organ pushes through an opening in the muscle or tissue that holds it in place. Lumbar hernia is a protrusion of either extraperitoneal fat or intraperitoneal contents through either of the lumbar triangles. Lumbar hernia is an uncommon abdominal wall hernia, making its diagnosis and management a challenge to the treating surgeon. The key in assessment is the orientation and location of the bowel relative to the duodenum and colon. Surgical repair is the only definitive treatment option through either an open or laparoscopic approach. What are the treatment options for a lumbar hernia. Primary lumbar hernias are extremely rare thereby rendering such a case reportable, to create an. Because a lumbar hernia is a type of abdominal hernia, it needs surgery to treat the opening in the abdomen wall.
Open hernia repair involves an incision at the hernia site. A lumbar hernia, also known as a flank hernia, is a certain type of hernia that occurs after an operation usually to surgically treat a kidney or lung problem or after a traumatic injury to the abdominal wall. Hernia abdominal hernia 9 types, symptoms, causes, and. Flank lumbar hernia a flank hernia, also known as a lumbar hernia, results from defects in the posterolateral abdominal wall that allows the tissues inside the abdomen to protrude. A hernia is a protrusion, bulge, or projection of an organ or part of an organ through the body wall that normally contains it. According to hafner et al, 1 a general surgeon will only have the opportunity to repair 1 lumbar hernia case in his or her lifetime. Rehabilitation of sports hernia involving adductor tenotomy, ilioinguinal neurectomy and osteitis pubis an appendix follows this protocol for examples of exercises in each phase of rehabilitation. An imaging study forms an indispensable aid in the. Pdf lumbar hernias develop through the weakening of the posterolateral abdominal wall associated with the petits triangle or the. They can be classified anatomically into superior or inferior lumbar hernias based on two welldefined areas of weakness.
Awareness of the anatomical basis of this hernia is important for proper diagnosis and treatment. Most commonly they involve the abdomen, specifically the groin. Lumbar hernias are a rare form of posterior abdominal hernia. Presentation may be misleading and diagnosis often missed. An imaging study forms an indispensable aid in the diagnosis and surgery is the only treatment option. We report the case of a 40yearold caucasian woman with a superior lumbar hernia grynfeltt hernia initially misdiagnosed as a recurrent lipoma. Lumbar hernia is a relatively rare defect of the posterior abdominal wall, with approximately 300 cases reported in the literature. Abdominal hernias occur when part of or an organ of a body cavity protrudes through a defect in the wall of that cavity. The vessels and nerves lie between the internal and innermost layers. 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.
There are three layers, an external, internal and innermost layer. A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. The key to successful repair of a sliding hernia is the recognition of the visceral component and the. Lumbar hernia is a rare abdominal wall defect that usually presents spontaneously after trauma or lumbar surgery or, less frequently, during infancy congenital. Because ct portrays the anatomic relationships in this region so well, it may be the only radiographic procedure necessary to make the diagnosis of a lumbar hernia. The internal oblique muscle arises from the lumbar fascia, the iliac crest and the lateral twothirds of the inguinal ligament and runs. The layers of the abdominal wall include skin, subcutaneous tissues, superficial fascia, deep fascia, muscle, extraperitoneal fascia and peritoneum1. Conclusion traumatic lumbar hernia is a relatively rare injury of the posteriolateral abdominal wall. The most common site is the groin, accounting for nine out of 10 hernias. Our practice uses the newest techniques and materials. Other hernias include hiatus, incisional, and umbilical hernias. An abdominal hernia is an abnormal protrusion of bowel that is generally classified by the area where the protrusion occurs. We hypothesized that anchoring our repair to fixed bony structures would reduce recurrence rates. The grynfelttlesshaft hernia is a rare posterior abdominal wall defect that allows for the herniation of retro and intraperitoneal structures through the upper lumbar triangle.
This type of hernia occurs on the side of the abdominal wall and can cause back pain and marked deformity. A commonly misevaluated condition of the bilateral. Congenital hernias are usually small in size at the time of presentation. Two types are described, according to the anatomical location of the hernial neck. Patients with lumbar hernias can present with a variety of symptoms, including a posterolateral mass, back pain, bowel obstruction if contents contain bowel, or urinary obstruction if contents are. Abdominal computed tomography ct will provide accurate diagnosis. Pitfalls and clinical recommendations for the primary lumbar hernia.
There is little research available on the protocol for sports hernia rehabilitation. Di direct inguinal hernia, eiv external iliac vessels, f femoral hernia, iev inferior epigastric vessels, ii indirect inguinal hernia, il inguinal ligament, l lumbar hernia, ob obturator hernia. Recently, a therapeutically aimed classification was proposed analysing the size, location, contents, muscular atrophy, origin, and existence of the previous recurrence. Note also the interparietal hernia through the right lateral aspect of the abdominal wall arrowhead containing the hepatic. Today, this situation in many centers has changed with the creation of functional units where patients can be centralized and. Paraduodenal hernia is the most common type of internal hernia left greater than right.
Most abdominal wall hernias should be evaluated by a surgeon when identified. The retroperitoneal fat which was herniating through this defect. A lumbar hernia will grow larger over time resulting in symptoms ranging from mild to intense pain in addition to a knot or bulge in the back. Lumbar hernias most frequently occur as a result of traumatic injury to the back or side of the abdominal wall, but may also result from surgery e.
It consists of surgery of the abdominal wall synthesis in a posterolateral region. The abdominal wall congenital lumbar hernia is a rare condition, there are around 50 cases describe in the english literature. An abdominal hernia occurs when an organ or other piece of tissue protrudes through a weakening in one of the muscle walls that enclose the abdominal cavity. Diffuse lumbar hernias are most often iatrogenic kidney operations overlapping and imbricating suture mesh reinforcement repairs sciatic hernia. Followup of its results in the mid and long terms dr. Lumbar hernia is defined as the presence of failure in the transversalis fascia and. Management of lateral abdominal hernias springerlink. Controversies in the current management of lumbar hernias. There are two different types, depending on the location. Incarcerated umbilical hernia in a 56yearold woman. Perineal, incisional, and parastomal hernias are not shown.
It is imperative to identify the true type of a hernia by reducing if possible the intestinal loop into the abdominal cavity. Lumbar hernia is a rare abdominal wall defect and clinical suspicion is necessary for diagnosis. Previous surgery included a paraumbilical hernia repair, anterior vaginal wall repair and a spinal fusion. Cureus management criteria of grynfeltts lumbar hernia.
An obvious swelling beneath the skin of the abdomen or the groin. 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 misdiagnosed as a subcutaneous lipoma. Lateral abdominal wall hernias are rare defects but, due to their location, repair is difficult, and recurrence is common. See your doctor promptly if you cant push the hernia back in with gentle pressure, or you experience increased pain, nausea, fever, swelling or darkening of the skin over the hernia. Lumbar, pelvic, and uncommon hernias sciencedirect. The hernia sac should be opened on the anteromedial border because the visceral component most commonly constitutes the posterolateral wall of the hernia sac. The superior lumbar triangle, also known as the triangle of grynfelttlesshaft, is one of the locations for a lumbar hernia gross anatomy boundaries. A hernia is the protrusion of organs, such as intestines, through a weakened section of the abdominal wall. Extremely unusual hernias, difficult to diagnose, and the patient may be. Lumbar hernias develop through the weakening of the posterolateral abdominal wall associated with the petits triangle or the grynfelttlesshaft triangle. Lumbar hernias are quite uncommon as compared to other ventral abdominal wall hernias, accounting for less than 1. The nature of the repair depends upon the size and location of the.
Abdominal hernia, ventral hernia, incarcerated hernia, strangulated hernia, irreducible hernia, reducible hernia. A hernia is caused by organs, such as intestines, pushing through a weakened section of the abdominal wall. To date, approximately 300 cases have been reported in the. Few studies exist to support a standard protocol for repair of these lateral hernias. The lumbar abdominal wall hernia is a rare hernia in which abdominal contents protrude through a defect in the dorsal abdominal wall, which. Lumbar hernias are uncommon defects of the posteriolateral abdominal wall. Grynfeltts lumbar hernia is a rare abdominal wall pathology with around 300 cases described in the literature. Most common in patients aged between 50 and 70 years with a male predominance 1. Barbette was the first, in 1672, to suggest the existence of lumbar hernias. For inguinal, femoral, umbilical, and incisional hernias, symptoms may include. In this paper, we describe the main mdct findings in abdominal wall hernias, including umbilical,epigastric, hypogastric, inguinal, spigelian, lumbar, obturator. Lumbar hernias occur through defects in the lumbar muscles or the posterior fascia, below the 12 th rib and above the iliac crest.
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