Inferior lumbar triangle hernia as a rarely reported cause of low back pain: a report of 4 cases

Lillie, Gregory R.; Deppert, Eric J

doi:10.1016/j.jcm.2010.02.001

Cited by 25 publications

(25 citation statements)

References 15 publications

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“…The lumbar mass becomes more prominent on straining and coughing and reduces in size in prone position. Expansile cough impulse is positive in a minority of patients (as found in our case) 1 3. Diagnosis of these hernias may be missed as these are very rare cases.…”

Section: Discussionsupporting

confidence: 49%

Lumbar hernia: a diagnostic dilemma

et al. 2014

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Lumbar hernia is one of the rare cases that most surgeons are not exposed to. Hence the diagnosis can be easily missed. This leads to delay in the treatment causing increased morbidity. We report a case of lumbar hernia in a middle-aged woman. It was misdiagnosed as lipoma by another surgeon. It was a case of primary acquired lumbar hernia in the superior lumbar triangle. Clinical and MRI findings were correlated to reach the diagnosis. We also highlight the types, the process of diagnosis and the surgical repair of lumbar hernias. We wish to alert our fellow surgeons to keep the differential diagnosis of the lumbar hernia in mind before diagnosing any lumbar swelling as lipoma.

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Section: Discussionsupporting

confidence: 49%

Lumbar hernia: a diagnostic dilemma

et al. 2014

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“…2003; Armstrong et al. 2008; Lillie & Deppert, 2010). Petit’s triangle overlaps the caudolateral portion of LR.…”

Section: Discussionmentioning

confidence: 99%

A description of the lumbar interfascial triangle and its relation with the lateral raphe: anatomical constituents of load transfer through the lateral margin of the thoracolumbar fascia

et al. 2012

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Movement and stability of the lumbosacral region is contingent on the balance of forces distributed through the myofascial planes associated with the thoracolumbar fascia (TLF). This structure is located at the common intersection of several extremity muscles (e.g. latissimus dorsi and gluteus maximus), as well as hypaxial (e.g. ventral trunk muscles) and epaxial (paraspinal) muscles. The mechanical properties of the fascial constituents establish the parameters guiding the dynamic interaction of muscle groups that stabilize the lumbosacral spine. Understanding the construction of this complex myofascial junction is fundamental to biomechanical analysis and implementation of effective rehabilitation in individuals with low back and pelvic girdle pain. Therefore, the main objectives of this study were to describe the anatomy of the lateral margin of the TLF, and specifically the interface between the fascial sheath surrounding the paraspinal muscles and the aponeurosis of the transversus abdominis (TA) and internal oblique (IO) muscles. The lateral margin of the TLF was exposed via serial reduction dissections from anterior and posterior approaches. Axial sections (cadaveric and magnetic resonance imaging) were examined to characterize the region between the TA and IO aponeurosis and the paraspinal muscles. It is confirmed that the paraspinal muscles are enveloped by a continuous paraspinal retinacular sheath (PRS), formed by the deep lamina of the posterior layer of the TLF. The PRS extends from the spinous process to transverse process, and is distinct from both the superficial lamina of the posterior layer and middle layer of the TLF. As the aponeurosis approaches the lateral border of the PRS, it appears to separate into two distinct laminae, which join the anterior and posterior walls of the PRS. This configuration creates a previously undescribed fat-filled lumbar interfascial triangle situated along the lateral border of the paraspinal muscles from the 12th rib to the iliac crest. This triangle results in the unification of different fascial sheaths along the lateral border of the TLF, creating a ridged-union of dense connective tissue that has been termed the lateral raphe (Spine, 9,1984, 163). This triangle may function in the distribution of laterally mediated tension to balance different viscoelastic moduli, along either the middle or posterior layers of the TLF.

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“…Anatomically, this represents the hernial orifice of the inferior lumbar triangle (Petit's hernia), which is bounded by the external oblique muscle laterally, the latissimus dorsi medially and iliac crest inferiorly (11). Unique to our case, the PMR also extended simultaneously into the anterior thigh along the iliopsoas muscle.…”

Section: Discussionmentioning

confidence: 82%

Rare Presentation of Pseudomyxoma Retroperitonei: Stretching the Limits

Hasan

Kumar

Rao

et al. 2016

MJMS

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A 55-year-old woman presented with a mucopurulent sinusal discharge from the right supragluteal region, with symptoms over the previous five months. This abscess began as a slowly swelling growth, which eventually turned into a discharging sinus, and she was diagnosed with a gluteal abscess. The patient underwent incisional drainage, and intra-operatively, the sinus tract could be seen extending to the retroperitoneum. A subsequent CT scan and an MRI of the abdomen revealed a large heterogeneous retroperitoneal cystic mass on the right side of midline, extending inferiorly into the anterior thigh along the iliopsoas. Superiorly, a tubular projection extended from the lesion, indenting the ileocaecal junction, while a fluid filled cutaneous fistulous tract was seen, extending to the right flank. A diagnosis of pseudomyxoma retroperitonei, likely of retrocaecal appendicular origin, was proposed. An explorative laparotomy with an appendectomy, and the evacuation of the retroperitoneal collection were completed. The subsequent histopathology confirmed the diagnosis of appendicular mucinous cystadenoma, with pseudomyxoma retroperitonei.

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Inferior lumbar triangle hernia as a rarely reported cause of low back pain: a report of 4 cases

Abstract: Anatomical knowledge and clinical acumen led to correct diagnosis of these rare lumbar hernias. This information should help both medical and chiropractic clinicians detect these conditions, and aid in appropriate management.

Cited by 25 publications

References 15 publications

Lumbar hernia: a diagnostic dilemma

Lumbar hernia: a diagnostic dilemma

A description of the lumbar interfascial triangle and its relation with the lateral raphe: anatomical constituents of load transfer through the lateral margin of the thoracolumbar fascia

Rare Presentation of Pseudomyxoma Retroperitonei: Stretching the Limits

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