Concurrent Spigelian and Grynfeltt-Lesshaft Hernias

Only 0.12% to 2% of diagnosed hernias are Spigelian type. Even less frequently encountered—Grynfeltt-Lesshaft hernias—hernias have unknown incidence. A Spigelian hernia is encountered along the Spigelian fascia and Grynfeltt-Lesshaft hernias are bounded by the superior lumbar triangle. These unique hernias can both be intermuscular, given their anatomical borders which allow concealment and preclusion of accurate diagnosis. Here, an 86-year-old male presented with symptoms consistent with small bowel obstruction. On physical exam, a right lower quadrant hernia and right posterior flank mass were appreciated. Computed tomography revealed obstruction secondary to bowel incarceration within Spigelian hernia and additional Grynfeltt-Lesshaft hernia. The patient underwent reduction and repair of Spigelian hernia with synthetic mesh, while repair of asymptomatic hernia was deferred. These unusual hernias are difficult to distinguish, given their negligible occurrence and unreliable exam findings. Clinicians must remain cognizant of their features to aid in diagnosis and mitigate potential sequelae.

LUMBAR HERNIA -POST TRAUMATIC SEQUALAE-TWO LAYER MESHPLASTY– A CASE REPORT

Lumbar hernia arises through posterolateral abdominal wall defects either through superior lumbar triangle [Grynfeltt-Lesshaft] or inferior lumbar triangle [Petit]. Most of the lumbar hernias are secondary to trauma or previous surgery. Few cases have been reported in literature. We report a case of post traumatic right Inferior triangle hernia of Petit in a 29-year-old healthy male. The hernial defect was closed with 2 layered procedure - sublay and onlay with polypropylene mesh, owing to a big defect and thin abdominal wall muscles. Patient recovered well. Our two layered open meshplasty have been effective, safe and presents with good post-operative recovery. The patient was followed up regularly and there was no recurrence even after 1 year.

Bilateral Lumbar Hernias Following Spine Surgery: A Case Report and Laparoscopic Transabdominal Repair

Lumbar hernias are rare abdominal wall defects. Fewer than 400 cases have been reported in the literature and account for 2% of all abdominal wall hernias. Lumbar hernias are divided into Grynfelt-Lesshaft or Petit hernias. The former are hernia defects through the superior lumbar triangle, while the latter are defects of the inferior lumbar triangle. Primary lumbar hernias are further subdivided into congenital or acquired hernias and can further be classified as either primary or secondary. Secondary hernias occur after previous flank surgeries, iatrogenic muscular disruption, infection, or trauma. We review a rare presentation of metachronous symptomatic bilateral secondary acquired lumbar hernia following spine surgery. A successful laparoscopic transabdominal lumbar hernia repair with extraperitoneal mesh placement was performed, with resolution of the hernia symptoms. An extensive literature review regarding lumbar hernia and different types of repairs was performed.