A Rare Case of Grynfeltt-Lesshaft Hernia in an Elderly Patient

Abstract

Lumbar hernia, a rare and challenging condition in which abdominal contents protrude through defects in the posterolateral abdominal wall, has been recognized since the 17th century. It typically involves two key anatomical regions: the superior lumbar triangle (Grynfeltt-Lesshaft) and the inferior lumbar triangle (Petit). Due to the limited number of documented cases, a deep understanding of the specific anatomy and weaknesses in the lumbar region is crucial for accurate diagnosis and management. Diagnosing lumbar hernias can be difficult, often leading to misdiagnosis as lipomas or abscesses. Clinically, hernias present as bulges that tend to become more prominent with physical activity. A contrast-enhanced CT scan is essential for preoperative evaluation, though certain anatomical variations can complicate diagnosis. Surgical options include traditional open repairs and minimally invasive laparoscopic techniques, with mesh placement being commonly used. The choice of approach must be individualized, considering the hernia's size, contents, and the patient's overall condition. Despite advancements, achieving optimal outcomes remains challenging due to the complexity of the involved anatomy. Whether congenital or acquired, a Grynfeltt-Lesshaft hernia requires heightened awareness and a solid understanding of lumbar anatomy for early diagnosis. In resource-limited settings, open repair may be the most practical surgical approach. Effective management relies on a comprehensive clinical evaluation and the selection of the appropriate surgical technique to minimize recurrence and ensure the best possible patient outcomes.

Keywords: grynfelt-lesshaft hernia; grynfelt-lesshaft hernia repair; hernia; lumbar hernia; open hernia surgery.

Figure 1. A pre-operative image displaying swelling in the right lumbar region.

Figure 2. Contrast-enhanced CT abdomen showing herniation of bowel loops with omentum in the right lumbar region (white arrow).

Figure 3. An intraoperative image showing the defect.

Figure 4. The defect is being closed primarily with Prolene sutures using a continuous technique.

Figure 5. Intraoperative image of Prolene mesh being placed over the defect.

Figure 6. Image showing skin closure using skin staplers.