Congenital lumbar herniae: a systematic review.

PURPOSE: Congenital lumbar hernia is defined as the protrusion of intraperitoneal or extraperitoneal viscera through a defect of the posterior abdominal wall, present at birth. The aim of our study was to perform a systematic review of this rare pathology, with emphasis on surgical decision-making. METHODS: The English literature (2000-2020) was reviewed, using PubMed, EMBASE and GoogleScholar databases, combining the terms "hernia", "lumbar", "flank", "Grynfeltt", "Petit" and "congenital". Overall, 35 studies were included, describing 85 patients. RESULTS: Mean age was 9.7 ± 20.7 months (range 1 day-10 years). 55.7% were males and 44.3% were females. All patients presented electively, with flank bulging as the main symptom. Superior lumbar triangle (Grynfeltt) herniae accounted for 41.8%, inferior lumbar triangle (Petit) herniae for 32.8%, whereas 25.4% were classified as diffuse. A left-sided hernia was observed in 47%, a right-sided in 42.4%, while 10.6% were bilateral. 71.8% of the patients had associated anatomical anomalies, mainly the lumbocostovertebral syndrome. Most patients (83.3%) were treated surgically, while 16.7% conservatively with surveillance. In 93.3%, the surgical approach was open, with laparoscopy employed in 6.7% of cases. The majority (71.7%) underwent primary suture repair of the hernia defect, whereas a mesh was required in 28.3%. Post-operative morbidity was 6.7% and recurrence rate was 3.3% at a mean follow-up of 26.4 months. CONCLUSION: Congenital lumbar hernia is a rare pathology in the paediatric population, with only 85 cases reported since 2000. Although the diagnosis is frequently straightforward, it should raise the suspicion for associated congenital anomalies and further investigation is required, with cross-sectional imaging. Surgical repair is usually performed during the first year, to allow for symmetrical torso development.

Síndrome lumbocostovertebral: primer reporte de caso en Argentina / Lumbocostovertebral syndrome: first case report in Argentina

El síndrome lumbocostovertebral se define por la presencia de hernia lumbar, hemivértebras y anomalías costales. El objetivo de este trabajo es describir el primer caso reportado en Argentina. El paciente fue comunicado a la Red Nacional de Anomalías Congénitas de Argentina. Se describe el cuadro clínico, los diagnósticos diferenciales y los posibles mecanismos patogénicos involucrados. Se sugiere que esta entidad sea considerada como una asociación. La hernia lumbar en un recién nacido es un hallazgo infrecuente y debe pesquisarse la presencia de otras anomalías asociadas.

Lumbocostovertebral syndrome is defined by the presence of lumbar hernia, hemivertebrae and costal anomalies. Our aim was to describe the first case reported in Argentina. The patient was reported to the National Registry of Congenital Anomalies of Argentina. The clinical picture, differential diagnoses and possible pathogenic mechanisms involved are described. We suggest considering this as a lumbocostovertebral association. Lumbar hernia in a newborn is an infrequent finding and other associated anomalies should be evaluated.

[Lumbocostovertebral syndrome: first case report in Argentina]. / Síndrome lumbocostovertebral: primer reporte de caso en Argentina.

Lumbocostovertebral syndrome is defined by the presence of lumbar hernia, hemivertebrae and costal anomalies. Our aim was to describe the first case reported in Argentina. The patient was reported to the National Registry of Congenital Anomalies of Argentina. The clinical picture, differential diagnoses and possible pathogenic mechanisms involved are described. We suggest considering this as a lumbocostovertebral association. Lumbar hernia in a newborn is an infrequent finding and other associated anomalies should be evaluated.

El síndrome lumbocostovertebral se define por la presencia de hernia lumbar, hemivértebras y anomalías costales. El objetivo de este trabajo es describir el primer caso reportado en Argentina. El paciente fue comunicado a la Red Nacional de Anomalías Congénitas de Argentina. Se describe el cuadro clínico, los diagnósticos diferenciales y los posibles mecanismos patogénicos involucrados. Se sugiere que esta entidad sea considerada como una asociación. La hernia lumbar en un recién nacido es un hallazgo infrecuente y debe pesquisarse la presencia de otras anomalías asociadas.

Hernia de Petit congénita en un escolar. Reparación con malla protésica. Reporte de caso / Congenital Petit's hernia in a Escolar. Prosthetic Mesh Repair. Case Report

Resumen Introducción: La hernia lumbar de pared abdominal congénita es una condición rara, existen alrededor de 50 casos publicados en la literatura inglesa; se clasifican según su sitio anatómico de aparición: en triángulo lumbar superior e inferior. Caso clínico: Paciente masculino, 6 años de edad, presenta masa en región lumbar izquierda, congénita, reducible, tamaño de 10 x 8 cm. El ultrasonido abdominal mostró defecto herniario compatible con hernia de Petit congénita. Se realizó reducción del saco herniario con plastía anterior y colocación de malla protésica en el defecto. Discusión: El triángulo de Grynfelt-Lesshaft es más grande y constante que el de Petit, este último representa el lugar menos común de localización. Se describen varias técnicas de reparación, pero la hernioplastía anterior es la más recomendada. Conclusiones: La hernia lumbar debe considerarse como diagnóstico diferencial en todo recién nacido que presenta masa en flanco izquierdo o derecho al nacimiento, con presencia o ausencia de otra malformación. El diagnóstico temprano evita complicaciones y permite el tratamiento oportuno, ofreciendo una mejor calidad de vida al paciente.

Introduction: The abdominal wall congenital lumbar hernia is a rare condition, There are around 50 cases describe in the English literature. These are classified according to their anatomical site of appearance, upper or lower lumbar triangle. Case presentation: A 6-year-old male patient presented congenital left mass in the lumbar region, reductible, size 10 x 8 cm; during abdominal ultrasound, hernia was compatible with Petits congenital hernia. A reduction of the hernial sack with anterior plasty and placement of the prosthetic mesh at the defect site was performed. Discussion: The triangle of Grynfelt-Lesshaft, is larger and more constant than the triangle of Petit, the latter represents the least common location. Several repair techniques are described, but anterior hernioplasty is the most recommended. Conclusion: Lumbar hernia should be considered as a differential diagnosis in all newborns with protruding mass on the left or right flank at birth, accompanied or not by another obvious or non-evident malformation. Early diagnosis avoids possible complications and allows for opportune treatment, allowing the patient a better lifestyle.

Congenital lumbar hernia-A feature of diabetic embryopathy?

Congenital lumbar hernia is a rare anomaly consisting of protrusion of abdominal organs or extraperitoneal tissue through a defect in the lateral abdominal wall. The majority of affected patients have additional anomalies in a pattern described as the lumbocostovertebral syndrome. We report four patients born to mothers with poorly controlled diabetes with congenital lumbar hernia. All patients exhibited features of lumbocostovertebral syndrome with lumbar hernia, multiple vertebral segmentation anomalies in the lower thoracic and/or upper lumbar spine, rib anomalies, and unilateral renal agenesis. Additional anomalies present in the patients included preaxial hallucal polydactyly, abnormal situs, and sacral dysgenesis, anomalies known to be associated with diabetic embryopathy. At least 11 other patients have been previously reported with the lumbocostovertebral syndrome in the setting of maternal diabetes. We suggest that congenital lumbar hernia and the lumbocostovertebral syndrome are related to diabetic embryopathy.

Early prenatal diagnosis of a lumbo-costo-vertebral syndrome.

Lumbo-costo-vertebral syndrome (LCVS) is a rare type of lumbar hernia with associated abnormalities of the vertebral bodies, ribs, and trunk muscles. Only a few cases have been reported in the literature, all of which were diagnosed after birth. We present a case of LCVS diagnosed early in the second trimester of pregnancy using two- and three-dimensional ultrasound. In our case, the associated anomalies were: multiple costovertebral anomalies, lumbar hernia, anal imperforation, left hand supernumerary digit, and clubfoot.

Bilateral congenital lumbar hernias in a patient with central core disease--A case report.

Congenital lumbar hernias are rare malformations caused by defects in the development of the posterior abdominal wall. A known association exists with lumbocostovertebral syndrome; however other associated anomalies, including one case with arthrogryposis, have been previously reported. We present an infant girl with bilateral congenital lumbar hernias, multiple joint contractures, decreased muscle bulk and symptoms of malignant hyperthermia. Molecular testing revealed an R4861C mutation in the ryanodine receptor 1 (RYR1) gene, known to be associated with central core disease. This is the first reported case of the co-occurrence of congenital lumbar hernias and central core disease. We hypothesize that ryanodine receptor 1 mutations may interrupt muscle differentiation and development. Further, this case suggests an expansion of the ryanodine receptor 1-related myopathy phenotype to include congenital lumbar hernias.

Lumbo-costo-vertebral syndrome with congenital lumbar hernia.

Lumbo-costo-vertebral syndrome (LCVS) is a set of rare abnormalities involving vertebral bodies, ribs, and abdominal wall. We present a case of LCVS in a 2-year-old girl who had a progressive swelling over left lumbar area noted for the last 12 months. Clinical examination revealed a reducible swelling with positive cough impulse. Ultrasonography showed a defect containing bowel loops in the left lumbar region. Chest x-ray showed scoliosis and hemivertebrae with absent lower ribs on left side. Meshplasty was done.

Lumbocostovertebral Syndrome with Congenital Bilateral Lumbar Hernia / 대한주산의학회잡지

Lumbocostovertebral syndrome is a rare type of congenital lumbar hernia. Its features include lumbar hernia associated with genitourinary, vertebral, and rib anomalies. About 30 cases have been reported in the English literature, but in Korea, there has not been a case reported. We experienced a neonate with multiple costovertebral anomalies and bilateral lumbar hernia with liver and small intestine herniation diagnosed by physical examination and computed tomography. We report a case of a congenital lumbocostovertebral syndrome in neonate with literature review.

A Case of Congenital Lumbar Hernia / 대한소아소화기영양학회지

An lumbar hernia is a rare clinical disease entity thatarises from the superior or inferior lumbar triangle and presents as a reducible protruding mass in the flank region between twelfth rib and the iliac crest. There are two classifications one classification is a congenital or acquired hernia according to the occurrence timing and the other classification is a superior (Grynfeltt-Lesshaft hernia) or inferior (Petit's hernia) lumbar hernia according to the anatomical location. Approximately 10% of all lumbar hernias are congenital and the vast majority of them are unilateral. We report here a case of a congenital lumbar hernia through the superior lumbar triangle of Grynfeltt-Lesshaft without any other congenital anomalies or complications in a four-month-old male. It was treated successfully with a surgical repair.