What Is a Lumbar Hernia?
Occurred in the posterior outer wall of the twelfth rib to the iliac crest, posterior peritoneal fat and / or intra-abdominal tissue organs pass through the weak defect of the upper or lower lumbar triangle here and protrude beyond the abdominal surface formed by the body surface Hernias are called lumbar hernias and also called dorsal hernias. 65% are males and 35% are females. The elderly are more common. There are many causes of lumbar hernia, and the diagnosis is not difficult. After the diagnosis is confirmed, adult lumbar hernia is mainly treated by surgery.
Basic Information
- nickname
- Dorsal hernia
- Visiting department
- General Surgery
- Multiple groups
- Male elderly
- Common causes
- Anatomical factors, trauma, increased abdominal pressure, waist muscle atrophy, etc.
- Common symptoms
- Congenital lumbar hernia: when children cry, there is a semicircular protruding mass above the diaphragm, between the last part of the external oblique and the latissimus dorsi; acquired lumbar hernia: no discomfort
Causes of lumbar hernia
- The occurrence of lumbar hernia includes the following multiple factors, and there are large individual differences.
- Anatomical factors
- The human waist is relatively strong and is not prone to hernia, but the lack of muscle protection in the lumbar triangle formed by the staggering of certain muscle groups is a congenital factor that causes lumbar hernia, accounting for about 19% of lumbar hernias.
- Trauma
- Of the acquired pathogenic factors, about 26% are traumatic and surgically-derived, because lumbar trauma or poor healing of local incisions (such as after nephrectomy) results in a weaker lumbar triangle.
- 3. Increased intra-abdominal pressure
- It accounts for 55% of cases of lumbar hernia, mainly due to chronic cough, long-term constipation, poor urination, and other reasons that increase intra-abdominal pressure and induce the disease.
- 4. Waist muscle atrophy
- For example, lumbar muscle atrophy caused by sequelae of polio, or obese muscle atrophy, further reduces the protective effect of muscles and fascia, and makes the lumbar triangle area weaker.
Clinical manifestations of lumbar hernia
- Lumbar hernia can be divided into two types: congenital and acquired.
- Congenital lumbar hernia
- Occurred in children shortly after birth, generally when children cry, above the diaphragm, between the last part of the external oblique and the latissimus dorsi muscle, a semi-circular protrusion mass is found, soft, no tenderness, normal skin, The intestine located in the tumor can often be touched, bowel sounds can be heard when pressing, the tumor can grow when crying, and disappear when quiet, and the oval defect can be touched in the lateral posterior abdominal wall after receiving.
- 2. Acquired lumbar hernia
- Occurs more often in the elderly. Most of the patients complained of no discomfort, only a slow-increasing mass was seen in the waist, the texture of the mass was soft and easy to receive, it was obvious when standing, and disappeared in the prone position; some patients had local swelling or stretch. Coughing may be felt on palpation. Huge lumbar hernias can be accompanied by indigestion and other symptoms.
Lumbar hernia
- Ultrasound or CT examination can detect local defects and enter abdominal organs in the waist.
Lumbar hernia diagnosis
- A diagnosis can usually be made based on medical history, detailed physical examination, combined with ultrasound or CT imaging. However, sometimes it is necessary to distinguish it from lateral abdominal wall bulging caused by lateral abdominal wall incision surgery such as kidney. Lumbar hernia has obvious defects, but abdominal wall bulging can only see localized muscular thinning and no significant defect ring formation.
Lumbar Hernia Treatment
- Non-surgical treatment
- (1) Indications In children under 2 years of age, abdominal wall muscles will continue to develop with age, and local fissures may gradually decrease. Such congenital lumbar hernias may not be operated temporarily. Small lumbar hernia patients without obvious clinical symptoms. Those who have obvious contraindications to surgery.
- (2) The methods are all physical methods, using elastic abdominal bands for local protection. For pediatric patients, they can wait for further development to make the lumbar hernia self-heal. For adults, it can only prevent the hernia ring from increasing further and cannot be cured. .
- 2. Surgical treatment
- Lumbar hernia repair is the basic method of treatment.
- (1) Indications In children over 2 years of age, there is no significant reduction in hernia sac after non-surgical treatment. Lumbar hernia is large and has obvious clinical symptoms. incarcerated lumbar hernia.
- (2) The principles and methods of surgery can be open or laparoscopic surgery. Open surgery is relatively easy and has little interference with the abdominal cavity. Find the hernia ring during the open operation, free the hernia sac, the small hernia sac does not need to be opened, and the large hernia sac can recover the hernia contents, and then the hernia sac can be removed or inverted. Pediatrics are mainly used for local tissue repair. Adults can place patches. The repair method is to free the anterior peritoneal space and then insert the patch for Sublay repair. The defect above the patch can be closed or not closed.
Lumbar Hernia Prevention
- Avoid or reduce factors that increase intra-abdominal pressure, such as chronic cough, constipation, weight loss, etc. For trauma, surgery, polio, etc., abdominal belts should be used to strengthen local protection.