Incarcerated Grynfeltt-Lesshaft Hernia

Abstract

Superior lumbar triangle hernia, also known as Grynfeltt-Lesshaft hernia, denotes a subtype of abdominal wall hernia, and more specifically of lumbar hernia, occurring between the 12th rib, the internal oblique muscle, and the quadratus lumborum muscle. We report the case of a 92-year-old female patient in which this form of hernia occurred, complicated by incarceration and acute bowel obstruction. The discussion contains a short résumé of the different kinds of abdominal wall hernias.

Keywords: Abdominal wall hernia; Grynfeltt-Lesshaft hernia; computed tomography; incisional hernia; upper lumbar triangle hernia.

Figure 1

Grynfeltt-Lesshaft hernia. Abdominal supine plain radiograph of a 92-year-old woman with clinical bowel obstruction shows multiple dilated small bowel loops as well as distended cecum (C). The remaining colon is not aerated.

Figure 2

Grynfeltt-Lesshaft hernia in a 92-year-old woman. Axial (a, b) and coronally reconstructed (c) unenhanced abdominal computed tomography images show right posterolateral abdominal wall mass, consistent with incarcerated Grynfeltt-Lesshaft hernia containing right colon. (a) Hernia (squiggly arrow) is shown with afferent loop (straight arrow) in continuity with proximally dilated cecum (C). Note dilated small bowel loops (*). (b) Image slice at a slightly more cranial level shows efferent loop (arrow) leaving hernia sac. (c) Coronal reconstruction shows hernia sac in right abdominal wall (arrow). Right 11th rib is seen (arrowhead). Note also fat stranding next to hernia (*). Technical parameters: Philips Mx8000 IDT 16 CT scanner; tube voltage, 120 kVp; tube current 396 mA; slice thickness, 2 mm.