Hernias

Question 1

Inguinal Hernia

Question 2

Bochdalek Hernia- posterior diaphragmatic

Answer 2

A Bochdalek hernia is a form of congenital diaphragmatic hernia. They occur posteriorly and are due to a defect in the posterior attachment of the diaphragm when there is a failure of pleuroperitoneal membrane closure in utero. Retroperitoneal structures may prolapse through the defect, e.g. retroperitoneal fat or left kidney.

Question 3

Lumbar Hernia

Answer 3

A lumbar hernia may be primary or secondary with only about 300 cases of primary lumbar hernia reported in literature.

Lumbar hernias manifest through two possible defects in the posterior abdominal wall, the superior being more common.

Management remains surgical with various techniques emerging over the years.

Question 4

Lumbar Hernia- inferior triangle

Answer 4

The inferior triangle is upright, less constant and more vascular.

It’s boundaries are:

• posterior border of the external oblique muscle (anterior),
• anterior border of the latissimus dorsi muscle (posterior),
• iliac crest (base),
• superficial fascia (roof),
• internal oblique (floor).

The inferior triangle is commonly referred to as the lumbar triangle being more superficial in location and easily demonstrable.

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Question 5

Lumbar Hernia- Superior Triangle

Answer 5

The larger superior triangle is inverted, deeper and more constant. It’s boundaries are formed by

• posterior border of internal oblique (anterior),
• anterior border of sacrospinalis (posterior),
• 12th rib and
• the serratus posterior inferior muscle (base),
• external oblique and latissimus muscle (roof),
• aponeurosis of the transversus abdominis (floor).

For all practical purposes it is an avascular space.

Question 6

Lumbar Hernia- contents

Answer 6

The content of a lumbar hernia may be

• retroperitoneal fat,
• kidney,
• colon, or
• less commonly
  
  • small bowel,
  • omentum,
  • spleen,
  • appendix or
  • ovary