Teaching Case

A 45 years old male patient complaining of a lump in the left flank, associated with a dull, heavy, pulling feeling, underwent an abdominal CT.

A 45 years old male patient complaining of a lump in the left flank, associated with a dull, heavy, pulling feeling, underwent an abdominal CT. The exam showed small bowel loops herniating through the posterior abdominal wall.

Lumbar or dorsal hernias are hernias through the posterior abdominal wall at some level in the lumbar region. The most common sites (95%) are the superior (Grynfeltt’s) and inferior (Petit’s) lumbar triangle. A lump in the flank is the common complaint. With the patient erect, the presence of a reducible, often tympanitic mass in the flank usually makes the diagnosis. Incarceration and strangulation occur in about 10% of cases. Hernias in the inferior lumbar triangle are most often small and occur in young, athletic women. They present as tender masses producing backage and usually contain fat. Lumbar hernia must be differentiated from abscesses, haematomas, soft tissue tumours, renal tumours, and muscle strain. Lumbar hernias increase in size and should be repaired when found. Repair is by mobilization of the nearby fascia and obliteration of the hernia defect by precise fascia-to-fascia closure. The recurrence rate is very low