A Rare Entity With Dangerous Potential—Clinical Images From a Case of An Isolated Congenital Lumbar Hernia

Abstract

A 1-month-old female infant presented to the outpatient department with the complaint of a swelling in the left posterolateral abdominal wall since birth. There were no other associated symptoms such as vomiting, constipation, or fever. On physical examination, there was a large swelling in the left lumbar region measuring 8 cm in size with the defect size measuring approximately 3.5 cm. It was soft, non-tender, non-erythematous, and reducible on palpation (Fig. 1), with a positive cry impulse. On investigation, an X-ray dorsal spine showed herniation of the bowel loop and normal spine (Fig. 2A). Computed tomography abdomen showed bowel loops protruding into the swelling through a defect lying just superior to the left iliac crest (Fig. 2B). There were no associated congenital anomalies in the patient. The patient was diagnosed with lumbar hernia (LH). The patient was managed conservatively until the age of 2 years, after which an open-mesh repair was performed.LH is a relatively rare congenital defect in children, with only 85 cases reported since 2000. It can be classified as either congenital (20%) or acquired (80%) and has been reported in association with multiple congenital anomalies, such as lumbo-costo-vertebral syndrome (1). Differential congenital LH diagnoses include hematoma, abscess, soft tissue or renal tumors, and panniculitis (2). A timely surgical repair prevents hernial complications, reduces the need for emergency surgery, and allows symmetrical development of the child's torso. Small defects can be suture-repaired, while larger ones demand mesh hernioplasty (3).