Ann Surg Treat Res.  2018 Dec;95(6):340-344. 10.4174/astr.2018.95.6.340.

Traumatic lumbar hernia: clinical features and management

• Park Y
• Chung M
• Lee MA

• KMID: 2426766
• DOI: http://doi.org/10.4174/astr.2018.95.6.340

Abstract

PURPOSE
Traumatic lumbar hernia is rare, thus making diagnosis and proper treatment challenging. Accordingly, we aimed to investigate the clinical manifestations and proper management strategies of traumatic lumbar hernias.
METHODS
The medical records of patients with traumatic lumbar hernia treated at Gachon University Gil Hospital from March 2006 to February 2015, were retrospectively reviewed.
RESULTS
We included 5 men and 4 women (mean age, 55 years; range, 23-71 years). In 8 patients, most injuries were caused by motor vehicle collisions, including those wherein a pedestrian was struck (5 cases of car accidents, 2 falls, and 1 involving penetrating materials); in 1 patient, the probable cause was severe cough. Eight patients underwent hernia repair surgery (5 open and 3 laparoscopic), and a prosthetic mesh was used in 7 patients. Hernia repairs were elective in 7 patients; emergency hernia repair was performed with right hemicolectomy in 1 patient. No severe complication or recurrence was observed. Only 2 patients had mild complications, such as postoperative seroma.
CONCLUSION
Traumatic lumbar hernia is a relatively rare injury of the posteriolateral abdominal wall. Lumbar hernia should be suspected in patients with high-energy injuries of the torso, and all such patients should undergo abdominopelvic computed tomography. After diagnosis, hernia repair can be electively performed without complications in most cases.

Keyword

Lumbar hernia; Laparoscopic hernia repair; Trauma

MeSH Terms

Abdominal Wall
Accidental Falls
Cough
Diagnosis
Emergencies
Female
Hernia*
Herniorrhaphy
Humans
Male
Medical Records
Motor Vehicles
Recurrence
Retrospective Studies
Seroma
Torso

Figure

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  Fig. 1 Abdominopelvic CT scan (A: axial view, B: coronal view) shows the lumbar area wall defect (arrows).

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  Fig. 2 Mesh fixation. Transfascial fixations are used to fix mesh around the margin of the defect. The periphery of mesh is fixed to the abdominal wall with tacks and to the psoas muscle with sutures.

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  Fig. 3 Total extraperitoneal approach was used for laparoscopic hernia repair. Arrows indicate lumbar wall defect in the extraperitoneal space. Arrowheads indicate preperitoneal fat in the hernia site.

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  Fig. 4 Anatomic locations of lumbar hernias. (a) Superior lumbar hernia (Grynfeltt-Lesshaft triangle). (b) Inferior lumbar hernia (Petit triangle).

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