East African Medical Journal

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Primary lumbar hernia in an elderly woman: case report

S Ouma, P Mugabi, A Ocaya


Lumber hernia is a rare posterior abdominal wall defect with fewer than 300 cases reported in literature. It accounts for less than 1.5% of total hernia incidence. Herniation is mainly through the inferior lumber triangle (Petit’s hernia) or through the superior lumber triangle (Grynfeltt’s triangle); with both these anatomical boundaries accounting for 95% of lumber hernias. Lumber hernias are classified as either congenital (20%) or acquired (80%), and the typical presentation is a patient with a protruding bulge in the back with a slow growth. Our patient was a 70-year-old woman who presented at the surgical outpatient department with a swelling on the right flank for two years. She revealed no known cause of the swelling that was progressively increasing in size, with a dull pain. Physical examination and ultrasonography revealed a defect in the posterolateral abdominal wall. Surgical dissection revealed a large hernial sac, which contained retro peritoneal fat, protruding through a 3-4 centimetres defect in the transversalis fascia lining the floor of the superior lumbar triangle. The hernia sac was reduced and the defect closed. There was no recurrence four months post-operative. Lumber hernias are rare, but a good history and physical examination is important to rule out most of the differential diagnoses. Early surgical management is recommended but the surgical approach should be individualised.

AJOL African Journals Online