Petit s hernia is an uncommon abdominal wall defect in the inferior lumbar triangle. Get a printable copy pdf file of the complete article 876k, or click on a page image below to browse page by page. It herniates through the superior lumbar triangle grynfelttlesshaft triangle or inferior lumbar triangle petit triangle. The current management of lumbar hernias should reflect the development of modern imaging techniques and new forms of noninvasive treatment. Pdf incarcerated inferior lumbar petits hernia sedat. Lumbar hernias occur through defects in the lumbar muscles or the posterior fascia, below the 12th rib and above the iliac crest. Grynfeltts lumbar hernia is a rare abdominal wall pathology with around 300 cases described in the literature.
After the descent of the foetal testis into the scrotum from the retroperitoneum, the processus vaginalis should obliterate 3. 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. 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. 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 areoftenasymptomatic, butmayproduce lowback pain,colic,orapullingsensation thatmayresolve withreduction ofthehernia. A petit s lumbar hernia is, indeed, an extremely rare defect. Backgroundobjetives lumbar hernias are rare sumamentes less than 1% and reported rarely. Pdf management of giant inferior triangle lumbar hernia.
Petit lumbar herniaa doublelayer technique for tension. Right inferior lumbar hernia petit hernia, with bowel protruding as content, defect measuring 4. For example, in the case of an inguinal hernia, you may notice a lump on. 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. Inferior lumbar petit s hernia is an uncommon condition resulting from a defect in the posterior abdominal wall. The location of this type of hernia, also known as the grynfelttlesshaft hernia, is defined by a triangle placed in the lumbar region.
Lumbar hernia surgery is performed laparoscopically, which means with a laparoscopic camera through a small incision. Barbette, in 1672, first suggested the existence of a lumbar hernia. Ct findings shigeru suzuki, shigeru furui, kota okinaga, tsutomu sakamoto, jun murata, akira furukawa, yasuo ohnaka american journal of roentgenology. Superior lumbar triangle radiology reference article. Dec 10, 2009 lumbar hernia is a rare abdominal wall defect and clinical suspicion is necessary for diagnosis. A very simple technique to repair a superior lumbar hernia is described. 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. We present the case of a middleaged patient who presented with swelling in the left back. Lumbar hernia is a relatively rare entity with only 300 cases described in the literature. Lumbar hernias are rare and diagnostically challenging for surgeons.
A lumbar hernia is a rare pathological derangement of anatomy, especially when the postoperative type is excluded. Case discussion the inferior lumbar triangle also known as petit triangle is an anatomical space through which inferior lumbar hernias can occur. The operational team then blows air into the abdomen to make space for the camera and surgical tools. Abstract full text pdf 4597 kb pdf plus 1195 kb using ct to diagnose traumatic lumbar hernia karen l. Lumbar hernias lumbar hernias occur through defects in the lumbar muscles or the posterior fascia, below the 12th rib and above the iliac crest. Diagnosis isusuallyestablished bythepresence ofareducible softtissue massabovethe iliaccrest, which enlarges withthevalsalva maneuver or coughing. Incarcerated inferior lumbar petits hernia request pdf. Clinical presentation patients with lumbar hernias can present with a variety of sym.
This was diagnosed on barium enema and successfully treated surgically. Lumbar hernia misdiagnosed as a subcutaneous lipoma. Types of abdominal wall hernia total hernia repair center. The correct diagnosis was made intraoperatively and the hernia was repaired using synthetic mesh. 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. Lumbar hernias have been misdiagnosed as lipomas,, muscle strains, fibromas, abscesses, and kidney tumors, causing increased morbidity due to the incorrect diagnosis. Petit lumbar herniaa doublelayer technique for tensionfree. 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. A very simple technique to repair grynfelttlesshaft hernia.
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. It is named after french surgeon jean louis petit 16741750. This report describes an alternative technique for petit hernia repair. Pathophysiology a hernia can be classified as reducible or irreducible. We present a rare case of inferior lumbar hernia, leading to mechanical bowel obstruction, successfully treated with prosthetic mesh. We describe a 70yearold woman presenting with large bowel obstruction secondary to incarceration of the mid descending colon within a lumbar hernia.
Petit s hernia is a hernia that protrudes through the lumbar triangle. Request pdf ambulatory laparoscopic repair of inferior lumbar or petit hernia lumbar hernias are an uncommon variety of abdominal wall defect. The patient was free of recurrence at 4 months after. Grynfelttleschaft hernia is a type of lumbar hernia occurring in the superior lumbar triangle. Surgery for a petit hernia starts with a slight cut on or below the navel belly button. 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. We report a case of lumbar hernia in a middleaged woman.
A lumbar hernia an uncommon type of abdominal hernia that develops in the lumbar region of the back. 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. 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. The neck the spot where the hernia protrudes into the opening is large, and therefore this hernia has a lower risk. Garagngeot in 1731 and description of the anatomical limits of the inferior space was by petit 1783, and superior space was by grynfeltt 1866. We present a rare case of inferior lumbar hernia, leading to mechanical bowel obstruction, successfully treated with. In 1750, ravaton pub lished the first report of a patient with. Given their rarity and their nonspecific presentation, lumbar hernias are an easy diagnosis to overlook. A 70yearold male with a reducible left sided superior lumbar hernia.
Controversies in the current management of lumbar hernias. We report the case of a 40yearold caucasian woman with a superior lumbar hernia grynfeltt hernia initially misdiagnosed as a recurrent lipoma. Grynfelt hernias are the most common and occurred in all patients of our series. Surgical repair is the only definitive treatment option through either an open or laparoscopic approach. The superior lumbar triangle, also known as the triangle of grynfelttlesshaft, is one of the locations for a lumbar hernia. Abd wall hernias university of tennessee college of medicine. Lumbar hernias are a rare form of posterior abdominal hernia. 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. Management of incidental lumboiliac hernia during spinal. What is the inferior lumbar triangle of petit relative to. Incarcerated inferior lumbar petits hernia springerlink.
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. An unusual case of a 67yearold woman with a superior lumbar hernia is reported. Lumbar hernia is the protrusion of intraperitoneal or extraperitoneal contents through a defect of the. However, in most cases, lumbar hernias are the result of old age. 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. Incidence in 1902, vonbaracz reported 68 records of true lumbar hernias which he found in the world literature, but only 3 of these stated the exact anatomic location. Diffuse lumbar hernias are most often iatrogenic kidney operations overlapping and imbricating suture mesh reinforcement repairs sciatic hernia. Lumbar hernia is one of the rare cases that most surgeons are not exposed to. Recently, a therapeutically aimed classification was proposed analysing the size, location, contents, muscular atrophy, origin, and existence of the previous recurrence. 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. This leads to delay in the treatment causing increased morbidity. 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.
Colonic incarceration through the inferior lumbar triangle, which causes mechanical obstructive symptoms, necessitates particular diagnostic and management strategy. Lumbar hernias are rare and on the basis of etiology are classified into congenital or acquired, representing 20% and 80% of cases, respectively. Hernia lumbar hernia open repair prosthetic mesh repair d orsal or lumbar hernias are found in the. Lumbar hernias are rare defects involving two weak areas of the posterolateral wall that may be congenital or adquired. Such hernias may be difficult to diagnose on the basis of physical signs and. It was a case of primary acquired lumbar hernia in the superior lumbar triangle. It can be classified as congenital or acquired, which may be primary or secondary.
A rare complication following delayed breast reconstruction with extended latissimus dorsi myocutaneous flap. Lumbar hernias occur in a area of the back called the lumbar. A lumbar hernia is a posterolateral body wall hernia where the bowel, omentum, or preperitoneal fat herniates through the lumbar triangles. The most common symptom of a hernia is a bulge or lump in the affected area. It stems from a traumatic injury auto accident 10 yrs ago. Theres a natural weak spot in the lower back called the superior lumbar triangle or grynfelttlesshaft triangle. As lumbar hernias are rarely discussed in literature, many orthopedists or radiologists do not suspect a hernia as the cause of low back pain. Ct scan is considered to be the gold standard for the diagnosis and evaluation of the contents of lumbar hernia. A case of strangulated hernia was described by petit in 1738, occurring through the inferior lumbar triangle, and this now bears his name. The treatment of lumbar hernias should follow the concept of tensionfree surgery, and the preperitoneal space can be the best place for prosthesis placement.
Traumatic lumbar hernia tlh constitutes an uncommon acquired form of abdominal wall hernia. Many surgeons are not familiar to lumbar hernias, which frequently leads to misdiagnosis and delay of treatment. Of the two, the superior triangle is the more consistently found in cadavers, and is more commonly the site of herniation. 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. Full text full text is available as a scanned copy of the original print version. Epidemiology most common in patients aged between 50 and 70 years with a male predominance 1. If the processus vaginalis is not obliterated, fat or bowel may get into it. The neck of this hernia is usually large, and therefore, it has a lower risk of strangulation than other hernias 1. 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. Suggested by adrev masters admin sweet victory as featured in spongebob squarepants. Apr 10, 2003 petit s hernia is an uncommon abdominal wall defect in the inferior lumbar triangle.
Lumbar hernias are rare lesions that are usually observed after trauma or surgery. Looking to find a surgeon to repair it, it is a risky procedure and only 300 cases have ever been documented. Grynfeltt and lesshaft independently described superior lumbar hernias in 1866 and 1870, respectively. Following diagnostic studies, computed tomography confirmed left lumbar hernia. 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. Extremely unusual hernias, difficult to diagnose, and the patient may be. Ambulatory laparoscopic repair of inferior lumbar or petit hernia. Lumbar hernia is the protrusion of intraperitoneal or extraperitoneal contents through a. Up until 1946, watson 7 had collected 186 cases of lumbar hernia from the literature. Lumbar hernia causes a lumbar hernia can be either a congenital condition or the result of trauma to the back or abdomen.
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