Table of Contents

2017 Month : June Volume : 3 Issue : 1 Page : 1-3

PRIMARY GRYNFELTT S LUMBAR HERNIA- AN UNCOMMON OCCURRENCE

Deepak Sethi1, Anjali Sethi2

1Consultant Surgeon and SS (Surgery), Department of Surgery, RNT Medical College, Udaipur, Rajasthan.
2Associate Professor, Department of Surgery, Ananta Institute of Medical Sciences and Research Centre, Kaliwas, Rajsamand, Rajasthan.

Corresponding Author:
Deepak Sethi,
#303, Akshansh Apartment,
Keshav Nagar, Roopsagar Road,
Udaipur-313001, Rajasthan.
E-mail: deepanjali.d1972@gmail.com

ABSTRACT

BACKGROUND

Lumbar Hernia is an uncommon occurrence. It may occur through superior or inferior lumbar triangle. Hernia through superior lumbar triangle is more common. Treatment of lumbar hernia is essentially surgical with mesh repair, which may be done by open or laparoscopic techniques. Surgical management requires skill and expertise. We report a case of Lumbar Hernia through superior triangle (Grynfeltt’s). A 57 years old lean and thin patient presented with swelling in left loin on coughing. Diagnosis was confirmed by ultrasonography. Hernia was repaired by on-lay application of polypropylene mesh. Patient was asymptomatic at follow-ups.

KEYWORDS

Lumbar Hernia, Grynfeltt’s Hernia, Superior Lumbar Triangle, Inferior Lumbar Triangle, Mesh Repair.

How to cite this article

Sethi D, Sethi A. Primary Grynfeltts lumbar hernia- an uncommon occurrence. Journal of Evolution of General Surgery and Laparoscopy 2017; Vol. 3, Issue 1, Jan-June 2017; Page:1-3

BACKGROUND

Lumbar Hernia is an uncommon occurrence. A surgeon may come across with these hernias on a very few occasions in his life time. Lumbar Hernias account for approximately 2% of all abdominal wall hernias. Lumbar Herniation may occur through superior lumbar triangle (Grynfeltt’s Hernia) or inferior Lumbar Hernia (Petit’s Hernia). Lumbar Hernias may be congenital or acquired. Acquired hernias may be primary or secondary. We present a case of Primary Lumbar Hernia through superficial lumbar triangle.

CASE REPORT

A 57-year-old lean and thin male patient was presented to surgical outdoor with history of swelling on left side of his back for last 1 year. Swelling appeared while coughing or straining only and disappears after coughing. Swelling was smaller and asymptomatic initially. It gradually increased in size. He had no history of trauma or any surgical intervention at and around the local area.

On physical local examination, patient had slight retraction over left loin and a globular swelling appeared just below twelfth rib while coughing. On deep respiration, there was further retraction at loin and then a swelling measuring approximately 6 cm × 8 cm appeared on coughing. Swelling disappeared a few moments after coughing (Fig. 1).

Vital parameters and General Physical Examination were within normal limits except that patient was lean and thin with poor built and muscle mass. On ultrasonography, a defect of approximately 2 cm × 4 cm was observed in the muscular planes of left lumbar region below the twelfth rib. Rest of the examination was within normal limits. All routine investigations were within normal limits. So, decision of patient to be post for open hernioplasty was taken.

After informed risk consent, patient was given general anaesthesia and placed in right lateral position. Transverse incision was given below twelfth rib over the defect. After dissection of subcutaneous tissue, a defect of size approximately 2 cm × 4 cm was found in the muscular planes of superior lumbar triangle (Fig. 2). On exploration of the defect, a hernial sac was found. Hernial sac was reduced and defect in the muscular planes was closed with silk suture. A large on-lay polypropylene mesh was placed over muscles and was fixed on to the periosteum of twelfth rib superiorly, iliac crest inferiorly and to the muscles on medially and laterally and thus tension free mesh repair was done (Fig. 3). Post-operative period was uneventful. Suture removal was done on eighth post-operative day. Patient was asymptomatic at follow-ups.

 

Figure 1. Lumbar Hernia showing Impulse on Coughing


Figure 2. Defect in Muscular Planes



Figure 3. Tension Free Mesh Repair  of Lumbar Hernia