A 60-year-old Hispanic man with history of diabetes mellitus, status post left-leg below-the-knee amputation presented with several hours of worsening diffuse abdominal pain.
Prepared by Dr. Arias, Dr. Maximin, and Dr. de Silva, from
St. Vincent's Catholic Medical Centers of New York, Staten
A 60-year-old Hispanic man with history of diabetes mellitus,
status post left-leg below-the-knee amputation presented with
several hours of worsening diffuse abdominal pain. Patient was
discharged against medical advice. Figure 1 illustrates the scout
Lumbar hernia of the Petit's subtype
CT revealed a right lower lateral body wall defect containing
intra-abdominal fat, contrast-opacified cecum, and vermiform
appendix (figures 2 through 8). The study was obtained utilizing
7-mm contiguous sections through the abdomen with a pitch of 1.5
and 10-mm sections through the pelvis with a pitch of 1.0 following
administration of oral and intravenous contrast. The scanner was a
Siemens Somatom Plus 4 (Siemens Medical Systems, Erlangen,
Of the various types of abdominal hernias, the most unique are
arguably the lumbar hernias. There are approximately 300 cases
reported in the medical literature.
Most lumbar hernias are of the Grynfeltt-Lesgaft subtype, which is
defined by an inverted triangle bound by the 12th rib superiorly,
the internal oblique muscle anteriorly, and the erector spinae
Even more infrequent is the Petit's subtype. Petit's triangle is
bound by the iliac crest inferiorly, by the external oblique muscle
anteriorly, and by the latissimus dorsi muscle posteriorly.
The existence of this space is found in the adult consistently, but
not in the infant, therefore suggesting its development as a
by-product of body growth.
When these defects occur in the pediatric population, they are
thought to be congenital and are often associated with the
lumbo-costo-vertebral syndrome. This entity is composed of caudal
regression anomalies, diaphragmatic hernia, ureteropelvic junction
obstruction, cloacal exstrophy, and lipomeningocele.
The great majority of these hernias, however, occur in the adult
population, especially on the left side of the body and in
middle-aged men. Spontaneous lumbar hernias may represent true
attenuation of abdominal fascial layers secondary to the aging
process. These hernias can also occur iatrogenically following the
removal of the iliac crest for bone graft.
The contents inside these defects may include retroperitoneal
fat, kidney, or a bowel loop. Associated symptoms may range from
low back pain to intestinal obstruction.
Bowel incarceration occurs in up to 25% of cases and strangulation
in up to 10%.