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Case Reports
. 2023 Mar 5;15(3):e35789.
doi: 10.7759/cureus.35789. eCollection 2023 Mar.

Primary Petit Hernia: From Diagnosis to Open Surgical Approach

Duarte Gil Alves  1 , Jessica Sousa  2 , Catarina Rodrigues  1 , Sara Silva  1 , Rómulo Ribeiro  1
Affiliations
Case Reports

Primary Petit Hernia: From Diagnosis to Open Surgical Approach

Duarte Gil Alves et al. Cureus. .

Abstract

Lumbar hernias are quite rare, even more so when primary or of spontaneous nature. These defects in the lumbar region demand a comprehensive knowledge of the anatomy of the lateral abdominal wall and paraspinal muscles. Given the proximity of bone structures, they can pose a surgical challenge when trying to achieve an ideal dissection and appropriate mesh overlap. The authors report the case of a primary Petit's hernia that underwent an open anterior surgical approach with the use of a preperitoneal mesh. In addition to the described surgical technique, the article also aims to detail the diagnosis and anatomic classification of this rare pathology.

Keywords: abdominal hernia; lumbar hernia; open hernia surgery; petit's hernia; primary lumbar hernia; surgical mesh.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Axial (A), coronal (B), and sagittal (C) enhanced CT acquisitions showing a right inferior lumbar hernia with a neck size of 3.5 cm (arrow) and a hernia sac measuring 8.1cm by 4.9 cm containing adipose tissue and small bowel loops (triangle).
Figure 2
Figure 2. (A) Lateral left decubitus position showing the Petit’s triangle (inferior lumbar triangle) limited inferiorly by the iliac crest (white dotted line), anteriorly by the posterior border of the external oblique muscle (yellow dotted line) and posteriorly by the lateral border of the latissimus dorsi muscle (blue dotted line). The floor is composed by the internal oblique muscle. The lateral border of the rectus abdominis muscle is marked by the red dotted line; (B) An illustration of the patient’s position.
Figure 3
Figure 3. (A) Hernia sac freed from the surrounding fascial edges; (B) An illustration showing the hernia sac (yellow arrow) protruding superior to the iliac crest, posterior to the external oblique muscle (yellow asterisk) and anterior to the latissimus dorsi muscle (blue asterisk).
Figure 4
Figure 4. (A) Hernia reduced; (B) Primary closure of the muscle plane restoring the abdominal wall anatomy; (C) Final skin closure.
See this image and copyright information in PMC

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