Lumbar hernia: anatomical basis and clinical aspects.
BACKGROUND
The purpose of this study was to describe the anatomy of the two orifices of the abdominal posterior wall where lumbar hernias could appear. They may protrude through the superficial lumbar triangle (JL Petit) or the deepest superior orifice (Grynfeltt).


METHODS
The exact limits were precised by dissections in cadavers to explain the main differences of these two locations. We report two cases of spontaneous lumbar hernias discovered in outpatient clinic.


RESULTS
Clinical diagnosis was difficult and both the patients were sent for lumbar lipoma but a meticulous examination gave us a clue. MRI was useful to confirm the defect in the posterior abdominal wall under the 12th rib. Only one patient was operated by a direct approach with a reinforcement of an unabsorbable mesh. No recurrence appeared during follow-up.


CONCLUSIONS
Thanks to clinical and anatomical knowledge, these rare superior lumbar hernias were diagnosed and a correct surgical treatment permitted a quick recovery.
Laboratoire d'Anatomie, Faculté de Médecine de Nantes, Clinique de Chirurgie Digestive et Endocrinienne, Hôtel Dieu du CHU de Nantes, Nantes, France. olivier.armstrong@chu-nantes.fr
O
O
Armstrong
A
A
Hamel
B
B
Grignon
J M
JM
NDoye
O
O
Hamel
R
R
Robert
J M
JM
Rogez
D034861:Abdominal Wall / Q000473:pathology / Q000601:surgery*; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D046449:Hernia, Abdominal / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008161:Lumbosacral Region / Q000473:pathology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D013526:Surgical Mesh; D016896:Treatment Outcome