Kadler B, Shetye A, Patten D K, Al-Nowfal A
Academic Hepatology, Barts Health NHS Trust, Whitechapel , London , UK.
General Surgery, Homerton University Hospital NHS Foundation Trust , London , UK.
Ann R Coll Surg Engl. 2019 Apr;101(4):e96-e98. doi: 10.1308/rcsann.2019.0009. Epub 2019 Feb 18.
Lumbar hernias can be superior (Grynfelt) and inferior (Petit). Inferior lumbar hernias are extremely rare and, therefore, are associated with diagnostic difficulty. We present a case of a primary spontaneous inferior lumbar hernia in a 79-year-old woman that was initially diagnosed as a large lipoma on ultrasound. The first operation was abandoned and an open mesh repair was conducted. Lumbar hernias can be primary acquired (55%), secondary acquired (25%) or congenital (20%). Cross-sectional imaging by CT or MRI appears to be the gold standard in diagnosis as ultrasound may lead to misdiagnosis. Strangulation, incarceration and obstruction are recognised complications, requiring prompt surgical intervention. There are currently no guidelines for surgical managements, although laparoscopic surgery may give the best results. In view of the scarcity of published cases, we aim to add to the literature to raise the index of suspicion and to promote prompt surgical management of lumbar hernias.
腰椎疝可分为上腰椎疝（格伦费尔特疝）和下腰椎疝（佩蒂特疝）。下腰椎疝极为罕见，因此诊断困难。我们报告一例79岁女性原发性自发性下腰椎疝病例，该病例最初在超声检查中被诊断为巨大脂肪瘤。首次手术被放弃，随后进行了开放补片修补术。腰椎疝可分为原发性后天性（55%）、继发性后天性（25%）或先天性（20%）。CT或MRI横断面成像似乎是诊断的金标准，因为超声可能导致误诊。绞窄、嵌顿和梗阻是公认的并发症，需要及时进行手术干预。目前尚无手术管理指南，尽管腹腔镜手术可能效果最佳。鉴于已发表病例稀少，我们旨在补充文献，提高对腰椎疝的怀疑指数，并促进对腰椎疝的及时手术治疗。
