Bilateral Lumbar Hernias - A Case Report and An Overview of the Current Literature
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2017, Vol 1, Issue 5
Abstract
Primary lumbar hernia is a rare clinical entity. So far, around 300 cases have been described in the literature and almost all of them describe repair for unilateral hernias. We present a case of bilateral primary lumbar hernia repair at our institution. A 79 year old lady, who had enjoyed unremarkable health and was fully independent on her activity of daily living, was presented to us with self-detected bilateral loin swellings for one year. The swellings did not produce any symptoms of pain or discomfort and she denied any history of trauma to the region or symptoms of cough, constipation or urinary outflow obstruction. Physical examination revealed her Body Mass Index (BMI) to be 19.1kg/ m2. Abdominal examination found a non-distended abdomen and there was absence of surgical scars or ventral hernias. Bilateral lumbar protrusions were detected on upright (Figure 1), but they were completely reduced in prone position, which was compatible with lumbar hernias. Computer tomography (CT) scan demonstrated bilateral lumbar hernias just below the twelfth ribs. Retroperitoneal fat was seen inside the right hernia sac and a segment of descending colon was seen inside the left hernia sac (Figure 2). She later consented to an elective repair of her bilateral lumbar hernias under elective settings. She was admitted one day before the operation for assessment by the list anesthetist as well as for bowel preparation. Klean-Prep polyethylene glycol solution (Helsinn Healthcare S.A., Switzerland) was given in case bowel resection was indicated. She started fasting eight hours before the operation. Amoxicillin and clavulanic acid were given by intravenous route during induction of anesthasia. Repair of the bilateral lumbar hernias was performed under general anesthesia with endotracheal intubation. The patient was first positioned in right decubitus for the repair of the larger left side lumbar hernia. Although prone position had obvious advantage of allowing both sides repair to be performed without position change, we decided to carry out the lumbar hernias’ repair one side at a time in their respective decubitus positions in order to avoid the unnecessary risks associated with prone anesthesia [1,2].
Authors and Affiliations
Mina Cheng, Canon King-On Chan
Keywords
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- EP ID EP578763
- DOI 10.26717/BJSTR.2017.01.000450
- Views 165
- Downloads 0
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