Lumbar herniae are through the posterior abdominal wall at some level in the lumbar region.
The most common sites (95%) are:
- superiorly - Grynfeltt's triangle
- inferiorly - Petit's triangle
The patient presents with a "lump in the flank" associated with a dull, heavy, pulling feeling. Diagnosis is confirmed by the presence of reducible, often tympanic mass in the flank when the patient is erect.
Hernias through Grynfeltt's triangle often occur following an operation upon an infected kidney. Those through Petit's triangle often occur in young, athletic women. They tend to be small and present as tender masses producing backache. They usually contain fat.
Acquired hernias may be traumatic and caused by direct trauma, penetrating wounds, abscesses, and poor healing of flank incisions. Congenital hernias occur in infants and are usually isolated unilateral congenital defects.
The lumbar hernia must be differentiated from abscesses, haematomas, soft tissue tumours, renal tumours and muscle strain.
Lumbar hernias increase in size and should be repaired when found. Nearby fascia is mobilised and the hernial defect obliterated by precise fascia-to-fascia closure. The recurrence rate is low.