Traumatic Lumbar Hernias Research Articles

Traumatic lumbar hernias, when should I operate? A case report

Traumatic lumbar hernias, when should I operate? A case report

Traumatic lumbar hernias: do patient or hernia characteristics predict bowel or mesenteric injury?

Traumatic lumbar hernias are rare but important injuries to diagnose in blunt abdominal trauma, both because of delayed complications of the hernia itself and because of well-documented association with bowel and mesenteric injuries. No study to our knowledge has determined whether specific features of the hernia-size of the wall defect, inferior or superior location, or the side of the hernia-bear any predictive value on the presence of underlying bowel and mesenteric injury. A retrospective query of the radiology information system yielded 21 patients with lumbar hernias which were diagnosed on CT. These were reviewed by three radiologists to confirm the presence of an acute lumbar hernia and to determine the size and location of the hernia. The patients' medical records were reviewed to determine the presence of operatively confirmed bowel and/or mesenteric injuries, which occurred in 52 % of patients. A significant (p < 0.001) difference was found in the frequency of bowel and/or mesenteric injury with hernia defects greater than 4.0 cm (100 %) and those less than 4.0 cm (17 %). Larger hernias also resulted in more procedures (p = 0.042) and a trend towards longer ICU stay, but no difference in injury severity score (ISS) or overall hospital stay. No significant difference was seen in the frequency of bowel and/or mesenteric injuries based on side or location of the hernia, though distal colonic injuries were more commonly seen with left-sided hernias (50 %) compared to right-sided hernias (18 %). Although based on a small patient population, these results suggest that larger traumatic lumbar hernias warrant particularly close evaluation for an underlying bowel and/or mesenteric injury.

Lumbar Hernia: An Unusual Presentation of Bear Maul

Introduction: Typical lumbar hernias are very rare surgical conditions. Lumbar hernias can be congenital or acquired. About 25% of all lumbar hernias have a traumatic etiology. Case-Report: We here reported a case of a 55-year-old male who was mauled by a bear. The patient developed an atypical lumbar hernia after 6 months of sustaining craniofacial and abdominal trauma. Open hernioplasty, which was a very challenging job, was done in this patient. Conclusion: Post traumatic lumbar hernias have been reported but till today no case of lumbar hernia following an attack by a bear has been reported in literature. Both acute and long-standing post-traumatic lumbar hernias are rare but challenging conditions. The corrective surgical procedure becomes more complex as hernial defect enlarges. Reconstruction is a challenging aspect of lumbar hernia surgery.

Timing of traumatic lumbar hernia repair: is delayed repair safe? Report of two cases and review of the literature

Fewer than 100 cases of traumatic lumbar hernias are described in the English literature. The herniation has been described as a consequence of a combination of local tangential shearing forces combined with an acute increase in intra-abdominal pressure secondary to sudden deceleration sustained during blunt abdominal trauma. Delayed diagnosis is not uncommon, as nearly a quarter of these are missed at initial presentation. These hernias are best managed by operative intervention; however, there is no well-defined treatment strategy regarding either the timing or the type of repair. Several approaches, including laparoscopy, have been described to repair these defects. Various techniques, including primary repair, musculoaponeurotic reconstruction, and prosthetic mesh repair, have been described. These repairs are usually complicated because of the lack of musculoaponeurotic tissue inferiorly near the iliac crest. We describe here two cases of traumatic lumbar hernia managed by initial watchful waiting and subsequent elective repair using a combined laparoscopic and open technique and one with and one without bone anchor fixation.

Laparoscopic repair of traumatic lumbar hernia

Lumbar hernia—a defect in the posterolateral abdominal wall—is an uncommon problem. As of 1994, there were fewer than 300 such cases described in the world literature [1]. Although the majority (approximately 80%) of lumbar hernias are acquired, a minority of these are attributed to trauma. A recent review found just 66 cases in the English literature [2]. Most traumatic lumbar hernias are diagnosed acutely and are repaired at laparotomy. However, occasionally the diagnosis is delayed, or the hernia develops in delayed fashion. In that case, a variety of repair techniques are available. The laparoscopic approach oVers durable repair with a shorter hospital length of stay and potentially less complicated convalescence [3, 4]. Herein we report a case of delayed posttraumatic lumbar hernia, repaired laparoscopically. Case report

Traumatic lumbar hernia: Report of a case

Traumatic lumbar hernias are very rare. Here, we present a case of secondary lumbar hernia. A 44-year-old man sustained a crushing injury. On admission, ecchymotic, fluctuating swelling was present on his left flank with normal vital signs. Subcutaneous intestinal segments were revealed at his left flank on abdominal CT. Emergency laparotomy revealed a 10-cm defect on the left postero-lateral abdominal wall. The splenic flexure was herniated through the defect. Herniated segments was reduced, the defect was repaired with a polypropylene mesh graft. There was also a serosal tear and an ischemic area 3 mm wide on the splenic flexure and was repaired primarily. The patient had an uneventful recovery. Most traumatic lumbar hernias are caused by blunt trauma. Trauma that causes abdominal wall disruption also may cause intraabdominal organ injury. Abdominal CT is useful in the diagnosis and allows for diagnosis of coexisting organ injury. Emergency laparotomy should be performed to repair possible coexisting injuries.

Traumatic Lumbar Hernia: Report of Cases and Comprehensive Review of the Literature

Acute lumbar hernia secondary to blunt trauma is an uncommon injury of the abdominal wall and, when encountered, is a difficult challenge for the trauma surgeon. Three cases of lumbar hernia secondary to blunt trauma are described and a review of the literature was conducted for other such cases. Clinical, anatomic, and demographic data were extracted from these reports and analyzed. Sixty-three cases of lumbar hernia secondary to blunt trauma were found in the English literature and three cases are described here. Hernias occurred most commonly in the inferior lumbar triangle (70%) and were most frequently a result of a motor vehicle collision (71%). Physical examination findings were variable and reported in only a minority of cases (palpable hernia, 33%; flank hematoma, 27%) and associated intra-abdominal injuries were common (61%). Most traumatic lumbar hernias were diagnosed immediately, and computed tomography was 98% sensitive for diagnosis. Fifty-eight percent of patients were managed initially with exploratory laparotomy. Timing of hernia repair was variable. Traumatic lumbar hernias are associated with a high incidence of intra-abdominal injury and should be considered in all cases of severe blunt abdominal trauma. Computed tomography should be implemented when the diagnosis is suspected in a hemodynamically stable patient. Repair should be performed by mesh patching techniques at a time based on clinical correlation.

Traumatic Lumbar Hernias: Difficulty with Diagnosis and Repair

Infrequently encountered, the traumatic lumbar hernia presents a challenge to the surgeon both in diagnosis and management. Repair is often complicated by a lack of viable fascia and a high incidence of associated injuries. The following review considers the natural history of lumbar hernias and their etiologies. Subsequently, the role of computed tomography (CT) in diagnosis is discussed. Finally, the multiple techniques of repair are presented, along with a discussion of the role of laparoscopy. Two case reports of traumatic lumbar hernias are presented, followed by a review of the literature and discussion. The case reports include a 36-year-old bicyclist who was thrown into a fixed roadway object and a 44-year-old victim of a side impact motor vehicle crash. The 36-year-old bicyclist underwent open repair with polytetrafluoroethylene (PTFE) and has done well at 7-month follow-up. The 44-year-old victim of a motor vehicle crash underwent open primary repair and has done well at 36-month follow-up. Traumatic lumbar hernias require a high index of suspicion in order to avoid the potential for incarceration and missed associated injuries. CT is helpful in making this diagnosis. Principles of hernia repair including freedom from tension and avoidance of compromised fascia are vital. Additionally, a thorough evaluation for associated injuries is paramount. Mesh should be used liberally and laparoscopy offers some advantage in the hands of the experienced.