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Grynfeltt-Lesshaft hernia

Giordano Rafael Tronco Alves^a, Régis Vinícius de Andrade Silva^b, José Roberto Missel Corrêa^b, Carlos Jesus Pereira Haygert^b

University of Santa Maria, Rio Grande do Sul State, Brazil

aDepartment of Clinical Medicine, Federal University of Santa Maria (Giordano Rafael Tronco Alves);
bRadiology Division, University Hospital of Santa Maria (Régis Vinícius de Andrade Silva, José Roberto Missel Corrêa, Carlos Jesus Pereira Haygert)

Conflict of Interest: None

Correspondence to: Dr. Giordano Rafael Tronco Alves, Department of Clinical Medicine, Federal University of Santa Maria, Roraima Avenue, 1000. 97105-900, Santa Maria, Rio Grande do Sul State, Brazil, Tel: +55(55)99159009, e-mail: grtalves@gmail.com

Received 4 November 2011; accepted 9 November 2011

A 76-year-old woman presented with a painful growing mass on her left lower back since 10 months. The pain was intermittent, but had become worse during the last 10 days. No history of previous procedures and trauma was reported. Physical examination showed a left lumbar tender mass which increased especially during Valsalva’s maneuver, just above the 12^th left rib, with no signs of incarceration or peritonitis. Laboratory tests, such as urinalysis and blood count were both unremarkable. Abdominal Computed Tomography (CT) revealed the presence of small bowel and mesenteric fat protruding through the superior lumbar space (Fig. 1), also known as the Grynfeltt-Lesshaft’s triangle, located in the upper posterolateral abdominal wall. Laparoscopic surgery was performed and confirmed the diagnosis of Grynfeltt-Lesshaft hernia. Subsequent follow-ups have been uneventful.

Back lumbar hernias are rare wall defects of the lumbar area [1-3], a region bound by the external oblique muscle laterally, the erector spinae muscle medially, the iliac crest inferiorly and the 12^th rib superiorly [1,2]. The region is divided into two spaces, the superior one known as Grynfeltt-Lesshaft’s triangle, and the inferior space, also called Petit’s triangle [1-3]. Grynfeltt-Lesshaft hernias are more common [1], as the superior triangle is larger [2]. Clinically, they may present from asymptomatic to painful masses, usually reducible and exercise-related [3]. Even though the diagnosis is clinical, CT imaging study is broadly recommended [1-3]. Its treatment remains surgical; however, the optimal technique should be selected on an individual basis.

References

1. Cesar D, Valadão M, Murrahe RJ. Grynfeltt hernia: case report and literature review. Hernia 2010 (in press).

2. Armstrong O, Hamel A, Grignon B, et al. Lumbar hernia: anatomical basis and clinical aspects. Surg Radiol Anat 2008;30:533-537.

3. Zhou X, Nve JO, Chen G. Lumbar hernia: clinical analysis of 11 cases. Hernia 2004;8:260-263.