The Retroperitoneoscopic Repair of a Lumbar Hernia of Petit Case report and Review of Literature

Abstract

In this paper, we comment on a patient who consulted us because of his "lower backpain" together with the appearance of a small swelling at the left side. Anamnesis and clinical examination were suggestive and further simple diagnostic methods confirmed the exceptional diagnosis of a "lumbar hernia of Petit". We describe the retroperitoneoscopic approach of this hernia, its reduction and the fixation of a polypropylene mesh at the surrounding structures with a Tacker. This approach provided a good postoperative comfort, a shorter hospital stay and an early recovery of autonomy and activity. Furthermore, we give a review of the literature concerning lumbar hernias and the evolution of the different reconstruction techniques.

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

“…Palpation will help confirm one common clinical finding, a bulge, also often discovered by the patient, over either triangle. 10,13 The bulge may become more noticeable when coughing or straining, sometimes receding when lying prone. As with the cases described above, palpation helps distinguish defects in the triangles.…”

Morphometric study of the triangle of Petit in human fetuses

“…[1][2][3][4][5][6][7] As reported, the most tenuous point of the lumbar triangle is the Hartmann fissure located at its apex. [11][12][13] Lower lumbar hernias may be both congenital and acquired, constituting 20% and 80% of cases, respectively.…”

“…The floor of the Petit triangle is part of the internal oblique muscle covered with the superficial fascia and subcutaneous tissue. [1][2][3][4][5][6][7] Precise data on the quantitative anatomy of the inferior lumbar triangle may be useful in anesthesiology, especially in anesthesia of the transversus abdominis plane (TAP), and in fetal surgery. TAP is located in the anterior abdominal wall between the transversus abdominis and the internal oblique muscle, and includes the lower intercostal nerves with concomitant blood vessels destined for the anterolateral abdominal wall.…”

Rare Presentations of Hernia

“…Two different types are encountered according to the anatomy. Superior lumbar triangle is bounded by 12th rib, paraspinal muscles, and the internal oblique muscles (Grynfeltt's triangle) While the Inferior lumbar triangle, which is bounded by the Iliac crest, latissimus dorsi muscle, and external oblique muscle leads to Petit's triangle hernia [10,11]. The overlapping nature of bulky muscles prevent the usual occurrence of hernias in these locations but acquired weakness after surgery, especially muscle cutting incisions or nerve damage leads to protrusion of lumbar fascia with extraperitoneal fat and an occasional hernial sac.…”