If the processus vaginalis is not obliterated, fat or bowel may get into it. Back lumbar hernia is a rare abdominal wall defect that usually presents spontaneously after trauma or lumbar surgery or, less frequently, during infancy congenital. While this hernia may initially present as a small asymptomatic bulge, the defect typically enlarges over time and can become symptomatic with potentially serious complications. Method the case of an 67yearold patient with a symptomatic grynfeltt lumbar hernia is reported. The defect was repaired primarily with using prolene mesh onlay, and the hemovac drains were abstract. Grynfelt and lesshaft described a hernia of the superior lumbar triangle in 1886 and 1870, respectively. In 1764, almost a century later, the flemish anatomist, josef klinkosch was acknowledged for recognizing and describing a hernia located in the spigelian fascia, and coined the term spigelian hernia. The most common location is the top of lumbar triangle, probably reflecting the fragility of this area, where the botton is just the transversal fascia. From april 2010 to september 2017, 12 cases of primary superior lumbar hernia grynfelt hernia were identified.
Repair of a grynfelttlesshaft hernia with the proceed. The most common location is the top of lumbar triangle, probably reflecting the fragility of. The surgical treatment of hernia requires an extensive knowledge and technical ability. In 1870, lesshaft independently reported a similar case lesshaft. The antimesenteric border of the intestine must protrude into the hernia sac the most common location is at the site of a femoral hernia. Due to the rarity of grynfelt hernia, there is no standardized surgical technique. The region is divided into two spaces, the superior one known as grynfelttlesshafts triangle, and the inferior space, also called petits triangle. A patent processus vaginalis alone is not sufficient for an indirect hernia to occur. Back lumbar hernias are rare wall defects of the lumbar area, a region bound by the external oblique muscle laterally, the erector spinae muscle medially, the iliac crest inferiorly and the 12th rib superiorly 1,2.
Definition hernia meansto bud or to protrude off shoot greek rupture latin hernia is defined as an abnormal protrusion of a viscous or a part of a viscous through an opening, artificial or natural with a sac, covering it. If the file has been modified from its original state, some details such as the timestamp may not fully reflect those of the original file. Few reports have been published in the literature describing primary lumbar hernia. Laparoscopic tapp repair of grynfeltt hernia sages abstract. Here, we describe an easy and safe surgical approach. After the descent of the foetal testis into the scrotum from the retroperitoneum, the processus vaginalis should obliterate 3. Grynfelttlesshaft hernia is a herniation of abdominal contents through the back, specifically through the superior lumbar triangle, which is defined by the quadratus lumborum muscle, twelfth rib, and internal oblique muscle. The lumbar region is an area bounded superiorly by the 12th rib, inferiorly by the iliac crest, medially by the erector spinae muscles, and laterally by the external oblique muscle. Prietodiaz, surgical department, san francisco medical center, colima, mexico summary. The patient lacked these risk factors, but he did have a history of 2 bilateral inguinal hernia repairs, the most recent being 3 years ago.
A very simple technique to repair grynfelttlesshaft hernia. A very simple technique to repair a superior lumbar hernia is described. More frequently lumbar hernia is unilateral, twice frequent on the left and in patients between the 5 th and 7 th decades of life 1,6,7. An unusual case of a 67yearold woman with a superior lumbar hernia is reported. Of the two, the superior triangle is the more consistently found in cadavers, and is more commonly the site of herniation. Laparoscopic tapp repair of grynfeltt hernia sages. It appears in the stomachs lower quadrant between an area of dense fibrous tissue and abdominal wall muscles causing a spigelian aponeurosis. This area of weakness or defect can be congenital or acquired. The location of this type of hernia, also known as the grynfelttlesshaft hernia, is defined by a triangle placed in the lumbar region. The diagnosis was made by physical examination and confirmed by computed tomography scan.
The history of the spigelian hernia became acknowledged in 1645, twenty years after spiegels death. A hernia is a protrusion of abdominal content through an area of weakness anywhere along the abdominal wall. A spigelian is the type of ventral hernia where aponeurotic fascia pushes through a hole creating a bulge. A patent processus vaginalis is relatively common in males, occurring in approximately 15. 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. This file is licensed under the creative commons attributionshare alike 3. This type of hernia is called inguinal because fat or part of the intestine slides through a weak area at the inguinal ring, the opening to the inguinal canal. Critical to the repair of richters hernia is an adequate evaluation of the intestine for viability. Lumbar hernia is a relatively rare disease in medical practice, so the aim of our study was to investigate.
Pathophysiology a hernia can be classified as reducible or. Due to the lack of systematic studies, the surgical approach must be chosen individually for each patient. Primary hernias in the triangle of grynfeltt are very rare and therefore pose a difficulty in diagnosis and treatment. Francisco barreiro morandeira and manuel bustamante montalvo. The grynfelttlesshaft hernia is a rare posterior abdominal wall defect that allows for the herniation of retro and intraperitoneal structures through the upper lumbar triangle. Surgical treatment of a superior lumbar hernia filmed with an onboard camera. Cleveland clinic, cleveland, ohio purpose a very simple laparoscopic technique to repair a superior lumbar hernia is described. An indirect inguinal hernia is a congenital lesion.
Grynfelttlesshaft hernia is a herniation of abdominal contents through the back, specifically through the superior lumbar triangle, which is defined by the quadratus lumborum muscle, twelfth rib, and internal oblique muscle history. It is the protuberance of, omentum, adipose or bowel in that weak space between the stomach muscles, that ultimately pushes the intestines or. Discusion y manejo by francisco javier gonzalez rodriguez, ana paulos gomez, marta lopez, rogelio felipe conde freire, salustiano gonzalez vinagre, francisco barreiro morandeira and manuel bustamante montalvo. A hernia is the exit of an organ, such as the bowel, through the wall of the cavity in which it normally resides.
A general surgeon will have the opportunity to repair only one or a few lumbar hernia cases in hisher lifetime. You may do so in any reasonable manner, but not in. The processus vaginalis must be patent for this type of hernia to occur. We report the case of a 53yearold male patient with a history of mental disability and pronounced scoliosis, who. An inguinal hernia occurs in the grointhe area between the abdomen and thigh. The fact that herniations occasionally occur here is of clinical importance.
Discusion y manejo francisco javier gonzalez rodriguez. Hernia lumbar viviana toaza luis trujillo william viteri 2. Meckel diverticulum as the sole component of the hernia sac. Grynfeltt described a hernia through the superior lumbar triangle in 1866 grynfeltt, 1866.
This file contains additional information such as exif metadata which may have been added by the digital camera, scanner, or software program used to create or digitize it. The defect of the posterior abdominal wall was repaired. Jul 31, 20 hernia of grynfeltt lumbar hernia in man of 55 years. May 30, 2018 primary hernias in the triangle of grynfeltt are very rare and therefore pose a difficulty in diagnosis and treatment. The floor of the inferior lumbar triangle is the internal abdominal oblique muscle. The present book is designed to focus on specific topics and problems which a general surgeon dealing with groin hernia is very likely to face during his practice. An inguinal hernia appears as a bulge on one or both sides of the groin. Describes a rare case of a 81yearold man with a spontaneous grynfeltts hernia.
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