Bone anchor fixation method of an incarcerated Petit hernia in an elderly lady: Optimal management of a rare case

Abstract

Background: The first reported lumbar hernia was in 1731. Since then, only about 300 cases have been reported in the literature. Approximately 20% of lumbar hernias are congenital and the remainder are acquired. They commonly occur in males, more frequently on the left side, and the majority are reported in the sixth-to-seventh decade of life. Based on the anatomical defect, lumbar hernias are classified into two types: superior (Grynfeltt-Lesshaft) and Inferior (Petit). Petit hernias are less common and their proximity to bone can make them more difficult to repair. Several methods for optimal repair have been proposed. Since 2004, only 7 reports advocated surgical management using the bone anchor fixation method. Case description: A 79-year-old obese female presented to the outpatient clinic with a 1-year history of moderate right lumbar pain. Examination revealed a tender bulge in the posterior lumbar region. CT of the abdomen & pelvis revealed a 6.6 cm × 7.4 cm defect in the right posterolateral abdomen incorporating parts of the right ascending colon. She was diagnosed with right-sided Petit lumbar hernia and underwent an open hernia repair with iliac crest anchor fixation and mesh implantation. The postoperative course was uneventful and the patient was discharged in a stable condition. Conclusions: Lumbar hernias represent a rare clinical phenomenon, especially in females. A protruding mass in the lumbar region with localized abdominal pain and radiographic evidence of posterior abdominal wall defect should raise suspicion for a lumbar hernia. Predisposing factors such as old age, obesity and conditions that increase intra-abdominal pressure increase the risk of lumbar hernia. There is a current dilemma centered on the optimal type of surgical approach and repair technique. In our case, an open repair using the bone anchor fixation technique led to excellent results.