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Heemskerk J, Leijtens JWA, van Steensel S. Primary Lumbar Hernia, Review and Proposals for a Standardized Treatment. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2023; 2:11754. [PMID: 38312404 PMCID: PMC10831689 DOI: 10.3389/jaws.2023.11754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/15/2023] [Indexed: 02/06/2024]
Abstract
A lumbar abdominal wall hernia is a protrusion of intraperitoneal or extraperitoneal contents through a weakness in the posterior abdominal wall, usually through the superior or inferior lumbar triangle. Due to its rare occurrence, adequate knowledge of anatomy and methods for optimal diagnosis and treatment might be lacking with many surgeons. We believe a clear understanding of anatomy, a narrative review of the literature and a pragmatic proposal for a step-by-step approach for treatment will be helpful for physicians and surgeons confronted with this condition. We describe the anatomy of this condition and discuss the scarce literature on this topic concerning optimal diagnosis and treatment. Thereafter, we propose a step-by-step approach for a surgical technique supported by intraoperative images to treat this condition safely and prevent potential pitfalls. We believe this approach offers a technically easy way to perform effective reinforcement of the lumbar abdominal wall, offering a low recurrence rate and preventing important complications. After meticulously reading this manuscript and carefully following the suggested approach, any surgeon that is reasonably proficient in minimally invasive abdominal wall surgery (though likely not in lumbar hernia surgery), should be able to treat this condition safely and effectively. This manuscript cannot replace adequate training by an expert surgeon. However, we believe this condition occurs so infrequently that there is likely to be a lack of real experts. This manuscript could help guide the surgeon in understanding anatomy and performing better and safer surgery.
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Affiliation(s)
- Jeroen Heemskerk
- Department of Surgery, Laurentius Hospital Roermond, Roermond, Netherlands
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2
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Kaur Y, Sinha M, Singh H. A Rare Case of Lumbar Hernia Secondary to an Iliopsoas Abscess: A Case Report. Cureus 2022; 14:e26967. [PMID: 35989851 PMCID: PMC9382995 DOI: 10.7759/cureus.26967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/05/2022] Open
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3
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Li J. The role of ultrasound in the diagnosis of Grynfeltt-Lesshaft lumbar hernia: A case report. Australas J Ultrasound Med 2021; 24:178-180. [PMID: 34765428 DOI: 10.1002/ajum.12276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 05/15/2021] [Accepted: 05/30/2021] [Indexed: 11/10/2022] Open
Abstract
Grynfeltt-Lesshaft hernia is a type of lumbar hernia located in the superior lumbar triangle. Lumbar hernias are rare hernias. Clinical diagnosis of lumbar hernias can be a challenging especially in obese or asymptomatic patients. Lumbar hernias have been frequently misdiagnosed and lead to serious complications. Surgery (open or laparoscopic) is recommended to correct the defect and to avoid the exacerbation of the hernia and associated complications. The majority of the reported cases in the past were diagnosed on a CT scan. This study presents a case of successful detection of a Grynfeltt-Lesshaft hernia by US scan then confirmed by a subsequent CT scan. The aim of this case report was to Increase knowledge of lumbar hernias and to demonstrate the role of US in the diagnosis of lumbar hernias.
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Affiliation(s)
- Jenny Li
- Department of Ultrasound Mercy Radiology Auckland New Zealand
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4
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Bilateral Lumbar Hernias Following Spine Surgery: A Case Report and Laparoscopic Transabdominal Repair. Case Rep Surg 2020; 2020:8859106. [PMID: 32802549 PMCID: PMC7415095 DOI: 10.1155/2020/8859106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/16/2020] [Accepted: 07/09/2020] [Indexed: 01/20/2023] Open
Abstract
Lumbar hernias are rare abdominal wall defects. Fewer than 400 cases have been reported in the literature and account for 2% of all abdominal wall hernias. Lumbar hernias are divided into Grynfelt-Lesshaft or Petit hernias. The former are hernia defects through the superior lumbar triangle, while the latter are defects of the inferior lumbar triangle. Primary lumbar hernias are further subdivided into congenital or acquired hernias and can further be classified as either primary or secondary. Secondary hernias occur after previous flank surgeries, iatrogenic muscular disruption, infection, or trauma. We review a rare presentation of metachronous symptomatic bilateral secondary acquired lumbar hernia following spine surgery. A successful laparoscopic transabdominal lumbar hernia repair with extraperitoneal mesh placement was performed, with resolution of the hernia symptoms. An extensive literature review regarding lumbar hernia and different types of repairs was performed.
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5
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Palumbo VD, Di Trapani B, Bruno A, Feo M, Molinelli B, Tomasini S, Lo Monte AI, Messina M, Tomasello G. Recurrent retroperitoneal abscess after biliary tract surgery in an elderly patient: a minimally invasive nonsurgical approach and its consequences: a case report. J Med Case Rep 2019; 13:43. [PMID: 30798788 PMCID: PMC6388486 DOI: 10.1186/s13256-019-1973-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 01/04/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction Hepatic abscess can be defined as an encapsulated collection of suppurative material within the liver parenchyma. Hepatic abscess can be distinguished as pyogenic, amebic, or fungal. Biliary tract disease remains the most common cause of hepatic abscess today, and the most common complications range from pleural effusion, empyema, and bronchohepatic fistula to subphrenic abscess and rupture into the peritoneal cavity, stomach, colon, vena cava, or kidney. A large abscess compressing the inferior vena cava and the hepatic veins may result in Budd-Chiari syndrome. In this report, we present a rare case of hepatic abscess with an unusual evolution that was treated with a noninvasive approach. Case presentation A 79-year-old Caucasian woman underwent endoscopic bile stone extraction and laparoscopic cholecystectomy. Six months later, a hepatic abscess in association with bilateral effusion was diagnosed. The prompt imaging-guided drainage solved the case. Three years later, she came to our attention complaining of dull, diffuse abdominal pain and high body temperature (38 °C). A retroperitoneal abscess was diagnosed that was spreading to the right lateral wall of the abdomen and extending across the muscular wall to the subcutaneous layer. The fluid collection also involved the right pleural cavity, forming an empyema. Also in this case, an imaging-guided drainage was performed, and the patient’s clinical picture resolved in a few days. The retroperitoneal abscess recurred 14 months later, and it was dealt with using the same treatment. Three months from the last follow-up, the patient came back to our attention with an evident swelling of her right lumbar region. Computed tomography revealed a right inferior lumbar hernia comprising adipose tissue and the right kidney. A surgical intervention was recommended to the patient, but, owing to her poor general health, she refused any invasive approach. Conclusions Retroperitoneal abscess is an uncommon complication of biliary tract surgery and represents a potential cause of death, especially in those patients with multiple diseases. Prompt drainage is crucial to the treatment. Failure in eliminating the primary infective focus could bring complications and, in general, a weakness of lumbar muscular wall, even resulting in a rare case of lumbar hernia.
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Affiliation(s)
- Vincenzo Davide Palumbo
- Euro-Mediterranean Institute of Science and Technology (IEMEST), Via Emerico Amari, 123, 90139, Palermo, Italy. .,Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy.
| | - Benedetto Di Trapani
- Euro-Mediterranean Institute of Science and Technology (IEMEST), Via Emerico Amari, 123, 90139, Palermo, Italy.,Casa di Cura Torina, Palermo, Italy
| | - Antonio Bruno
- Department of Diagnostic and Preventive Medicine, University of Bologna, Sant'Orsola, Malpighi Hospital, Bologna, Italy
| | | | | | | | - Attilio Ignazio Lo Monte
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | | | - Giovanni Tomasello
- Euro-Mediterranean Institute of Science and Technology (IEMEST), Via Emerico Amari, 123, 90139, Palermo, Italy.,Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
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6
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Kadler B, Shetye A, Patten DK, Al-Nowfal A. A primary inferior lumbar hernia misdiagnosed as a lipoma. Ann R Coll Surg Engl 2019; 101:e96-e98. [PMID: 30773901 DOI: 10.1308/rcsann.2019.0009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Lumbar hernias can be superior (Grynfelt) and inferior (Petit). Inferior lumbar hernias are extremely rare and, therefore, are associated with diagnostic difficulty. We present a case of a primary spontaneous inferior lumbar hernia in a 79-year-old woman that was initially diagnosed as a large lipoma on ultrasound. The first operation was abandoned and an open mesh repair was conducted. Lumbar hernias can be primary acquired (55%), secondary acquired (25%) or congenital (20%). Cross-sectional imaging by CT or MRI appears to be the gold standard in diagnosis as ultrasound may lead to misdiagnosis. Strangulation, incarceration and obstruction are recognised complications, requiring prompt surgical intervention. There are currently no guidelines for surgical managements, although laparoscopic surgery may give the best results. In view of the scarcity of published cases, we aim to add to the literature to raise the index of suspicion and to promote prompt surgical management of lumbar hernias.
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Affiliation(s)
- B Kadler
- Academic Hepatology, Barts Health NHS Trust, Whitechapel , London , UK
| | - A Shetye
- General Surgery, Homerton University Hospital NHS Foundation Trust , London , UK
| | - D K Patten
- General Surgery, Homerton University Hospital NHS Foundation Trust , London , UK.,Department of Surgery and Cancer, Imperial College London, Imperial Centre for Translational and Experimental Medicine, Hammersmith Campus , Du Cane Road, London, W12 0NN
| | - A Al-Nowfal
- General Surgery, Homerton University Hospital NHS Foundation Trust , London , UK
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7
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van Steensel S, Bloemen A, van den Hil LCL, van den Bos J, Kleinrensink GJ, Bouvy ND. Pitfalls and clinical recommendations for the primary lumbar hernia based on a systematic review of the literature. Hernia 2018; 23:107-117. [PMID: 30315438 PMCID: PMC6394702 DOI: 10.1007/s10029-018-1834-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 10/01/2018] [Indexed: 11/18/2022]
Abstract
Purpose The lumbar abdominal wall hernia is a rare hernia in which abdominal contents protrude through a defect in the dorsal abdominal wall, which can be of iatrogenic, congenital, or traumatic origin. Two anatomical locations are known: the superior and the inferior lumbar triangle. The aim of this systematic review is to provide a clear overview of the existing literature and make practical clinical recommendations for proper diagnosis and treatment of the primary lumbar hernia. Methods The systematic review was conducted according to the PRISMA guidelines. A systematic search in PubMed, MEDLINE, and EMBASE was performed, and all studies reporting on primary lumbar hernias were included. No exclusion based on study design was performed. Data regarding incarceration, recurrence, complications, and surgical management were extracted. Results Out of 670 eligible articles, 14 were included and additional single case reports were analysed separately. The average quality of the included articles was 4.7 on the MINORS index (0–16). Risk factors are related to increased intra-abdominal pressure. CT scanning should be performed during pre-operative workup. Available evidence favours laparoscopic mesh reinforcement, saving open repair for larger defects. Incarceration was observed in 30.8% of the cases and 2.0% had a recurrence after surgical repair. Hematomas and seromas are common complications, but surgical site infections are relatively rare. Conclusion The high risks of incarceration in lumbar hernias demand a relatively fast elective repair. The use of a mesh is recommended, but the surgical approach should be tailored to individual patient characteristics and risk factors.
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Affiliation(s)
- S van Steensel
- Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - A Bloemen
- Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,Department of Surgery, VieCuri Medical Centre, Venlo, The Netherlands
| | - L C L van den Hil
- Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - J van den Bos
- Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - G J Kleinrensink
- Department of Neuroscience, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - N D Bouvy
- Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands. .,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
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Abstract
Due to the rarity of Grynfelt hernia, there is no standardized surgical technique.From April 2010 to September 2017, 12 cases of primary superior lumbar hernia (Grynfelt hernia) were identified through medical records reviewing and included in our study. Perioperative data, surgical outcomes, and long-term follow-up results were retrospectively analysed.Male/female ratio of patients was 1:1, with age 69.5 (62, 74.5) [median (25 percentile, 75 percentile)] years old. Right/left side ratio of lumbar hernia was 9/3. The in-hospital duration was 7 (5, 8) days. The surgical duration was 35 (30, 50) minutes. The defect size was 2.1 (1.5, 3) cm in diameter. The discharge of the patient was on 3 (2, 4) post-operative day (POD). The meshes used were: MK5816 (10), MK5810 (1), and UHS (1). There was only 1 case of postoperative complication where the patient was admitted in intensive care unit (ICU) due to hypoxemia. Morbidity, mortality, and recurrence cases were null.Our study indicates that open surgery with mesh implantation is a reliable way for the management of primary superior lumbar hernia.
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9
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Suh Y, Gandhi J, Zaidi S, Smith NL, Tan MY, Khan SA. Lumbar hernia: A commonly misevaluated condition of the bilateral costoiliac spaces. TRANSLATIONAL RESEARCH IN ANATOMY 2017. [DOI: 10.1016/j.tria.2017.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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10
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Badji N, Deme H, Akpo G, Toure M, Ndong B, Niang EH. [Scannographic investigation in the diagnosis of inguinoscrotal bladder hernia]. Pan Afr Med J 2017; 25:126. [PMID: 28292088 PMCID: PMC5325488 DOI: 10.11604/pamj.2016.25.126.10280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 08/04/2016] [Indexed: 11/18/2022] Open
Abstract
We report the case of a patient aged 67 with a history of inguinal hernia, which featured a large painless purse evolving for several months associated with urinary disorders like urinary frequency. Ultrasound allowed highlight an emptiness of bladder lodge, urinary stasis and fluid collection in the scrotum that was mentioned a hydrocele. The abdominal pelvic CT revealed a bladder intra scrotal right situation associated with an inguinal hernia and direct left to bilateral urinary stasis. The diagnosis was confirmed by surgical exploration. The postoperative course was uneventful. The inguinoscrotal hernia exclusively bladder content is an exceptional entity. CT should be sought before any inguinoscrotal hernia associated with urinary disorders ( Mery 's Sign ).
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Affiliation(s)
- Nfally Badji
- Service de Radiologie Générale, Hôpital Aristide Le Dantect, Dakar,Sénégal
| | - Hamidou Deme
- Service de Radiologie Générale, Hôpital Aristide Le Dantect, Dakar,Sénégal
| | - Geraud Akpo
- Service de Radiologie Générale, Hôpital Aristide Le Dantect, Dakar,Sénégal
| | - Mouhamadou Toure
- Service de Radiologie Générale, Hôpital Aristide Le Dantect, Dakar,Sénégal
| | - Boucar Ndong
- Service de Radiologie Générale, Hôpital Aristide Le Dantect, Dakar,Sénégal
| | - El Hadji Niang
- Service de Radiologie Générale, Hôpital Aristide Le Dantect, Dakar,Sénégal
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11
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Ka I, Gueye ML, Thiam O, Akpo LG, Toure AO. Strangulated lumber hernias in adults: A case report and review of the literature. Ann R Coll Surg Engl 2016; 98:e160-e161. [PMID: 27412809 DOI: 10.1308/rcsann.2016.0211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Strangulated lumbar hernia is a very rare condition, with no more than 30 cases reported in the literature so far. Therefore, there is no specific management guideline and the diagnosis remains difficult. By reporting the case of a Senegalese male patient who had a preoperative diagnosis of strangulated lumbar hernia, we aim to discuss the diagnosis and therapeutic modalities of this rare entity, which is often misdiagnosed.
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Affiliation(s)
- I Ka
- General hospital of Grand Yoff , Dakar , Senegal
| | - M L Gueye
- Aristide Le Dantec Hospital , Dakar , Senegal
| | - O Thiam
- Aristide Le Dantec Hospital , Dakar , Senegal
| | - L G Akpo
- Aristide Le Dantec Hospital , Dakar , Senegal
| | - A O Toure
- Aristide Le Dantec Hospital , Dakar , Senegal
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12
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Hasan R, Kumar S, Rao AC, Kadavigere R. Rare Presentation of Pseudomyxoma Retroperitonei: Stretching the Limits. Malays J Med Sci 2016; 23:79-85. [PMID: 27660549 PMCID: PMC5025067 DOI: 10.21315/mjms2016.23.4.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 06/13/2016] [Indexed: 10/20/2022] Open
Abstract
A 55-year-old woman presented with a mucopurulent sinusal discharge from the right supragluteal region, with symptoms over the previous five months. This abscess began as a slowly swelling growth, which eventually turned into a discharging sinus, and she was diagnosed with a gluteal abscess. The patient underwent incisional drainage, and intra-operatively, the sinus tract could be seen extending to the retroperitoneum. A subsequent CT scan and an MRI of the abdomen revealed a large heterogeneous retroperitoneal cystic mass on the right side of midline, extending inferiorly into the anterior thigh along the iliopsoas. Superiorly, a tubular projection extended from the lesion, indenting the ileocaecal junction, while a fluid filled cutaneous fistulous tract was seen, extending to the right flank. A diagnosis of pseudomyxoma retroperitonei, likely of retrocaecal appendicular origin, was proposed. An explorative laparotomy with an appendectomy, and the evacuation of the retroperitoneal collection were completed. The subsequent histopathology confirmed the diagnosis of appendicular mucinous cystadenoma, with pseudomyxoma retroperitonei.
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Affiliation(s)
- Roumina Hasan
- Department of Pathology, Melaka Manipal Medical College, Manipal University, Manipal 576104, India
| | - Sandeep Kumar
- Department of Radiology, Kasturba Medical College, Manipal University, Manipal 576104, India
| | - Anuradha ck Rao
- Department of Pathology, Kasturba Medical College, Manipal University, Manipal 576104, India
| | - Rajagopal Kadavigere
- Department of Pathology, Melaka Manipal Medical College, Manipal University, Manipal 576104, India
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13
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Macchi V, Porzionato A, Morra A, Picardi EEE, Stecco C, Loukas M, Tubbs RS, De Caro R. The triangles of Grynfeltt and Petit and the lumbar tunnel: an anatomo-radiologic study. Hernia 2016; 21:369-376. [PMID: 27215430 DOI: 10.1007/s10029-016-1509-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 05/09/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE Lumbar hernias are protrusions of intra-abdominal contents classically through the superior (Grynfeltt) and inferior (Petit) lumbar triangles. The anatomy of the triangles is variable and quantitative data are few. No radiological data on the anatomy of the triangles are available. METHODS Fifty computed tomography angiography of the upper abdomen (M25, F25, mean age 72.5-year-old) were analyzed. The dimensions and the contents of the lumbar triangles were analyzed. The characteristics of the space between the two triangles were also documented. RESULTS The superior lumbar triangle showed a mean surface area of 5.10 ± 2.6 cm2. In the area of the triangle, the 12th intercostal pedicle and the 1st lumbar branches of the iliolumbar vessels were found in 42 and 46 %, respectively. The inferior lumbar triangle had a mean surface of area 18.7 ± 8.4 cm2. In this area, the 2nd, 3rd, and 4th lumbar branches were found in 9, 67, and 8 %, respectively. On oblique coronal images, a direct tunnel between the superior and the inferior lumbar triangles was found, showing an oblique course, with a postero-anterior direction (mean length 36.5 ± 5.8 mm, mean caliber 7.4 ± 3.1 mm). CONCLUSIONS Among the anatomical factors of weakening of the abdominal wall, the course of branches of the lumbar vessels was documented not only in the superior but also in the inferior lumbar triangle. A real musculoaponeurotic tunnel between the superior and the inferior lumbar triangles located in the oblique coronal plane was found, that could play a role in the development of incarceration or strangulation of lumbar hernias.
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Affiliation(s)
- V Macchi
- Department of Molecular Medicine, Institute of Human Anatomy, University of Padova, Via A. Gabelli 65, 35127, Padua, Italy
| | - A Porzionato
- Department of Molecular Medicine, Institute of Human Anatomy, University of Padova, Via A. Gabelli 65, 35127, Padua, Italy
| | - A Morra
- Section of Radiology, Euganea Medica Center, Via Colombo 3, Sant'Agostino Di Albignasego, Padua, Italy
| | - E E E Picardi
- Department of Molecular Medicine, Institute of Human Anatomy, University of Padova, Via A. Gabelli 65, 35127, Padua, Italy
| | - C Stecco
- Department of Molecular Medicine, Institute of Human Anatomy, University of Padova, Via A. Gabelli 65, 35127, Padua, Italy
| | - M Loukas
- Department of Anatomical Sciences, School of Medicine, St. George's University, True Blue, Grenada
| | - R S Tubbs
- Seattle Science Foundation, Seattle, WA, USA
| | - R De Caro
- Department of Molecular Medicine, Institute of Human Anatomy, University of Padova, Via A. Gabelli 65, 35127, Padua, Italy.
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14
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Samini F, Gharedaghi M, Khajavi M, Samini M. The etiologies of low back pain in patients with lumbar disk herniation. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e15670. [PMID: 25763198 PMCID: PMC4329753 DOI: 10.5812/ircmj.15670] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 02/08/2014] [Accepted: 04/09/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Low back pain (LBP) is a common complaint in population that lowers the quality of life. The main etiology of LBP is recognized in about 20% of patients while it is attributed to lumbar disk herniation (LDH) in 80% of cases and causes some unnecessary lumbar surgeries without realizing the definite cause. OBJECTIVES This study was planned to evaluate the etiologies of LBP in patients who had LDH to clarify whether the disc herniation is the main cause of patients` pain or other diseases were responsible for this kind of pain. MATERIALS AND METHODS In this cross-sectional study, we analyzed the medical profiles of the patients with proven LDH in a private clinic in Mashhad City, Iran, between 2005 and 2012, for demographic and the etiologies of LBP with clinical and paraclinical studies. We also calculated the incidence of each etiology by SPSS 13. RESULTS In our study, among 1250 patients with proven LDH by MRI, 500 patients (40%) had chronic LBP and the most common causes of LBP were heavy constant working (40.2%), osteoporosis (35.6%), and sacroiliac joint pain (34.6%), consecutively. Interestingly, LDH had the ninth rank among the common cause of LBP. CONCLUSIONS In this study, we found that in spite of previous beliefs, discopathies were not common etiologies of LBP. Thus, even in patients with proven LDH by imaging studies, the physician should perform a thorough evaluation for other causes of LBP to avoid unnecessary lumbar surgeries.
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Affiliation(s)
- Fariborz Samini
- Department of Neurosurgery, Trauma Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mohammad Gharedaghi
- Department of Neurosurgery, Trauma Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mahdi Khajavi
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mohammad Samini
- Research Center of Orthopedic, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding Author: Mohammad Samini, Research Center of Orthopedic, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: +98-9151111343, Fax: +98-5118012613, E-mail:
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15
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Munhoz AM, Montag E, Arruda EG, Sturtz G, Gemperli R. Management of giant inferior triangle lumbar hernia (Petit's triangle hernia): A rare complication following delayed breast reconstruction with extended latissimus dorsi myocutaneous flap. Int J Surg Case Rep 2014; 5:319-23. [PMID: 24794025 PMCID: PMC4066570 DOI: 10.1016/j.ijscr.2014.03.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 01/29/2014] [Accepted: 03/26/2014] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Lumbar triangle hernia after breast reconstruction with latissimus dorsi flap (LDMF) is a very rare complication and few cases were previously described. Muscle mobilization and iatrogenic fascia defect are related etiologic factors. PRESENTATION OF CASE The authors describe a rare case of lumbar hernia in a 58-year-old woman who underwent delayed left breast reconstruction with LDMF. Two months after surgery, a progressive symptomatic lower left lumbar bulge was observed. The CT scan confirmed the diagnosis and delineated an 18 cm lumbar defect filled with lower and large bowel. At operation, the defect was exposed and the hernia sac reduced. In order to obtain stability, the remained local muscle and fascia flaps were mobilized into the defect. Additional strength was achieved with a two-layer closure of prosthetic mesh (intra/extra peritoneal). The patient is currently in the 10th postoperative year of hernia repair and satisfactory lumbar wall contour was achieved. Neither the recurrence of lumbar hernia nor symptoms compliance was noted. DISCUSSION Lumbar hernia is an uncommon complication of LDMF harvest. Although it is a rare disease, general and plastic surgeons must be on alert to avoid complications and misdiagnosis. Seroma differential diagnosis is important in order to avoid bowel perforation due to aspiration. Defect reconstruction is necessary with a muscular and fascia flaps mobilization and synthetic mesh in order to obtain a stable repair. CONCLUSION The knowledge of this rare post-operative complication following delayed breast reconstruction is crucial to its surgical management. Early surgical intervention is warranted in order to avoid severe complications.
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16
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Ahmed ST, Ranjan R, Saha SB, Singh B. Lumbar hernia: a diagnostic dilemma. BMJ Case Rep 2014; 2014:bcr-2013-202085. [PMID: 24810439 DOI: 10.1136/bcr-2013-202085] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Lumbar hernia is one of the rare cases that most surgeons are not exposed to. Hence the diagnosis can be easily missed. This leads to delay in the treatment causing increased morbidity. We report a case of lumbar hernia in a middle-aged woman. It was misdiagnosed as lipoma by another surgeon. It was a case of primary acquired lumbar hernia in the superior lumbar triangle. Clinical and MRI findings were correlated to reach the diagnosis. We also highlight the types, the process of diagnosis and the surgical repair of lumbar hernias. We wish to alert our fellow surgeons to keep the differential diagnosis of the lumbar hernia in mind before diagnosing any lumbar swelling as lipoma.
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Affiliation(s)
- Syed Tausif Ahmed
- Department of General Surgery, Bankura Sammilani Medical College, Kolkata, West Bengal, India
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Traumatic lumbar hernia: can't afford to miss. Emerg Radiol 2014; 21:325-7. [PMID: 24424984 DOI: 10.1007/s10140-013-1193-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 12/30/2013] [Indexed: 10/25/2022]
Abstract
We describe the radiological and surgical correlation of an uncommon case of a traumatic lumbar hernia in a 22-year-old man presenting to the emergency department following a motor vehicle accident. Computed tomography (CT) of the abdomen revealed a right-sided traumatic inferior lumbar hernia containing a small amount of fat through the posterior lateral internal oblique muscle with hematoma in the subcutaneous fat and adjacent abdominal wall musculature, which was repaired surgically via primary closure on emergent basis. The purpose of this article is to emphasize the importance of diagnosing traumatic lumbar hernia on CT and need for urgent repair to avoid potential complications of bowel incarceration and strangulation.
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Suarez S, Hernandez JD. Laparoscopic repair of a lumbar hernia: report of a case and extensive review of the literature. Surg Endosc 2013; 27:3421-9. [PMID: 23636518 DOI: 10.1007/s00464-013-2884-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 02/15/2013] [Indexed: 01/10/2023]
Abstract
Lumbar hernias are a protrusion of intra-abdominal contents through a weakness or rupture in the posterior abdominal wall. 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. Petit described the inferior lumbar triangle in 1783 and Grynfeltt described the superior lumbar triangle in 1866; both are anatomical boundaries where 95% of lumbar hernias occur, whereas the other 5% are considered to be diffuse. Twenty percent of lumbar hernias are congenital and the other 80% are acquired; the acquired lumbar hernias can be further classified into either primary (spontaneous) or secondary. The typical presentation of lumbar hernias is a patient with a protruding semispherical bulge in the back with a slow growth. However, they may present with an incarcerated or strangulated bowel, so it is recommended that all lumbar hernias must be repaired as soon as they are diagnosed. The "gold standard" for diagnosing a lumbar hernia is a CT scan, because it is able to delineate muscular and fascial layers, detect a defect in one or more of these layers, evaluate the presence of herniated contents, differentiate muscle atrophy from a real hernia, and serve as a useful tool in the differential diagnosis, such as tumors. Recent studies have demonstrated the advantages of a laparoscopic repair instead of the classic open approach as the ideal treatment option for lumbar hernias. We report a case of a spontaneous lumbar hernia initially diagnosed as a lipoma and corrected with the open approach, but after relapsing 2 years later it was corrected using a laparoscopic approach. It is followed by an extensive review of lumbar hernias literature regarding history, anatomy, and surgical techniques.
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Affiliation(s)
- Sebastian Suarez
- School of Medicine, Universidad de Andes, Department of Surgery, Hospital Universitario Fundación Santa Fe de Bogota, Carrera 7 No 116-05, Cuarto Piso, Bogotá, Colombia
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Petersen K, Snikeris J, Hall TS. Bleichner's hernia - lumbar hernia. AMERICAN JOURNAL OF CASE REPORTS 2013; 14:26-9. [PMID: 23569557 PMCID: PMC3614380 DOI: 10.12659/ajcr.883760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 05/10/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND We present a case of a lumbar hernia and a review of the literature of this rare hernia type. CASE REPORT The case and the review will discuss the unusual presentations reported, common etiologies, the importance of early operative repair based on the high rate of incarceration and the recent recommendations regarding repair techniques. CONCLUSIONS Lumbar hernias are rare cases, but should be pursued in diagnosis and treated aggressively because of the high rate of incarceration. Repair can be accomplished with a minimally invasive technique.
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Affiliation(s)
- Katherine Petersen
- Department of Surgery, The Stamford Hospital, Columbia University, CT, U.S.A
| | - Jaclyn Snikeris
- Department of Surgery, The Stamford Hospital, Columbia University, CT, U.S.A
| | - Timothy S. Hall
- Department of Surgery, The Stamford Hospital, Columbia University, CT, U.S.A
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Schuenke MD, Vleeming A, Van Hoof T, Willard FH. A description of the lumbar interfascial triangle and its relation with the lateral raphe: anatomical constituents of load transfer through the lateral margin of the thoracolumbar fascia. J Anat 2012; 221:568-76. [PMID: 22582887 DOI: 10.1111/j.1469-7580.2012.01517.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Movement and stability of the lumbosacral region is contingent on the balance of forces distributed through the myofascial planes associated with the thoracolumbar fascia (TLF). This structure is located at the common intersection of several extremity muscles (e.g. latissimus dorsi and gluteus maximus), as well as hypaxial (e.g. ventral trunk muscles) and epaxial (paraspinal) muscles. The mechanical properties of the fascial constituents establish the parameters guiding the dynamic interaction of muscle groups that stabilize the lumbosacral spine. Understanding the construction of this complex myofascial junction is fundamental to biomechanical analysis and implementation of effective rehabilitation in individuals with low back and pelvic girdle pain. Therefore, the main objectives of this study were to describe the anatomy of the lateral margin of the TLF, and specifically the interface between the fascial sheath surrounding the paraspinal muscles and the aponeurosis of the transversus abdominis (TA) and internal oblique (IO) muscles. The lateral margin of the TLF was exposed via serial reduction dissections from anterior and posterior approaches. Axial sections (cadaveric and magnetic resonance imaging) were examined to characterize the region between the TA and IO aponeurosis and the paraspinal muscles. It is confirmed that the paraspinal muscles are enveloped by a continuous paraspinal retinacular sheath (PRS), formed by the deep lamina of the posterior layer of the TLF. The PRS extends from the spinous process to transverse process, and is distinct from both the superficial lamina of the posterior layer and middle layer of the TLF. As the aponeurosis approaches the lateral border of the PRS, it appears to separate into two distinct laminae, which join the anterior and posterior walls of the PRS. This configuration creates a previously undescribed fat-filled lumbar interfascial triangle situated along the lateral border of the paraspinal muscles from the 12th rib to the iliac crest. This triangle results in the unification of different fascial sheaths along the lateral border of the TLF, creating a ridged-union of dense connective tissue that has been termed the lateral raphe (Spine, 9,1984, 163). This triangle may function in the distribution of laterally mediated tension to balance different viscoelastic moduli, along either the middle or posterior layers of the TLF.
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Affiliation(s)
- M D Schuenke
- Department of Anatomy, University of New England College of Osteopathic Medicine, Biddeford, ME 04005, USA.
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