A 59 y.o. male comes in with a painful mass on the L flank after falling from a roof three days earlier
What is wrong?
A lumbar hernia
Our patient had a lumbar hernia. This is a relatively rare hernia where the abdominal contents protrude through the dorsal abdominal wall. The two locations for this type of hernia are the superior and inferior lumbar triangle. One is beneath the 12th rib and the other is over the iliac crest.
CT of our patient showing bowel outside the abdominal wall
The lumbar hernia was first described in 1672 by Barbette. About 20% of these hernias are congenital and the rest are secondarily acquired either primarily from a sudden increase in abdominal pressure or at a previous surgical site. It is recommended that the hernias be repaired if they are 4 cm or more in size.
Locations of lumbar hernias
Hernias can occur in many places. They simply represent a gap in the muscular wall where bowel protrudes. Common hernias include: inguinal, femoral , hiatal, ventral and incisional. Less common, and often missed, are Spigelian hernias which occur along the semilunar line. These hernias are more likely to incarcerate than other hernias with an estimated 27% becoming incarcerated.
The Spigelian hernia is lateral to the rectus
Our patient was given surgery follow up but elected not to have the hernia repaired.
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Mittal T, Kumar V, Khullar R, et al. diagnosis and management of Spigelian hernia: A review of literature and our experience. 2008 J Minim Access Surg. Oct-Dec;4():85-98.