Congenital lumbar hernia with lumbocostovertebral syndrome: a case report and review of the literature

Abstract

Introduction. Congenital lumbar hernia is one of the rare types of hernias. Anomalies of the ribs, spine, and muscles which constitute the lumbocostovertebral syndrome in association with congenital lumbar hernia make it the rarest of entities. In addition, a multitude of other organ systems may be involved. Case Report. A case of congenital lumbar hernia associated with lumbocostovertebral syndrome is presented in view of its rarity and diagnostic and therapeutic challenges. Discussion. Anatomical background of congenital lumbar hernia associated with various other anomalies especially of the musculoskeletal structures is discussed. All cases of congenital lumbar hernia should be investigated for other congenital anomalies. Both open and laparoscopic approaches have been described for surgical treatment. Conclusion. Open surgical intervention is the mainstay of treatment taking into consideration the technical challenges posed by distorted anatomy due to the associated congenital anomalies.

Figure 1

Left-sided congenital lumbar hernia.

Figure 2

X-ray of the chest region and abdomen showing absence of lower ribs on the left side and scoliosis.

Figure 3

CT scan showing severely hypoplastic posterior abdominal muscles (erector spinae, iliocostalis, and latissimus dorsi) causing posterolateral herniation of the spleen. D10–12 vertebral bodies are hemivertebrae.

Figure 4

The defect in the hypoplastic musculature.

Figure 5

Defect in the attenuated musculature with the sac dissected up to the neck.

Figure 6

A prosthetic mesh placed between the inverted sac and the muscular layer.

Figure 7

The defect closed over the mesh with overlapping flaps of the adjacent musculature.