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Primary superior lumbar hernia፡ a rare cause of lumbar swelling

Authors Mekonnen AG, Gonfa KB

Received 7 October 2018

Accepted for publication 12 February 2019

Published 4 March 2019 Volume 2019:12 Pages 67—70


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Cristina Weinberg

Peer reviewer comments 2

Editor who approved publication: Professor Ronald Prineas

Alemayehu Gonie Mekonnen,1 Kebebe Bekele Gonfa2

1Department of Nursing, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia; 2Department of Surgery, School of Medicine, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Ethiopia

Background: Superior lumbar hernia is a rare posterolateral abdominal wall defect and herniation of abdominal contents through the superior lumbar triangle. A lumbar hernia is an unusual defect and only 300 cases of primary lumbar hernias have been reported since the first case report in 1731. To date, most clinicians are usually unfamiliar with the presentation of lumbar hernias, and the diagnosis is often done in a wrong way.
Case report: A 55-year-old female patient presented with complaints of right flank pain and swelling on the right lumbar region. On abdominal examination, there was round protruding swelling immediately beneath the 12th rib of the right upper flank area. The swelling was palpable and bowel sound was heard over it. The swelling was easily reducible and protruded when the patient was coughing or straining. The opposite side of the lumbar region was normal, and chest examination was clear and normal. The hematological and urine analysis laboratory findings were normal.
Discussion: The ultrasound finding revealed the bowel contents within the hernial sac. With the diagnosis of primary acquired superior lumbar hernia, the patient underwent open surgery. The defect was reduced back and repaired using a retro-muscular or sublay prolene mesh (15 cm by 7.5 cm). The patient was discharged at post-operative day four and followed-up for four months.
Conclusion: In conclusion, the diagnosis of lumbar hernias should be considered in all patients presented with complaints of flank pain and swelling in the flank area. In the absence of obvious swelling in the flank region, ultrasound investigation might not establish the diagnosis of lumbar hernias. Hence, ultrasound would be the option to confirm the diagnosis when the swelling is palpable.

Keywords: lumbar hernia, right flank pain, mesh repair

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