Bilateral Lumbar Hernias with an Associated Large Bowel Obstruction: A Case Report

micr-089-anna-s-koerner
Anna S. Koerner, James M. Lopes, Joao A. Lopes, and Erin M. Duggan

Abstract

Background: There are very few cases in the literature of bilateral lumbar hernias with associated bowel obstruction, owing to the rarity of this clinical condition. In addition, lumbar hernias are often misdiagnosed or diagnosed late due to their frequent asymptomatic presentation and difficulty detecting on physical exam. However, prompt recognition and repair, as in this case, is critical to avoid bowel incarceration, obstruction, or strangulation.
Case: The patient was an 87-year-old woman with relevant past medical history of diverticulosis who presented with several days of diffuse abdominal pain, obstipation, nausea, and bilious emesis. The physical exam was notable for diffuse abdominal tenderness and distension, but no palpable hernias. Upon CT (Computerized Tomography) imaging, she was found to have bilateral lumbar hernias and associated large bowel obstruction requiring emergent surgical repair. The flank hernia containing bowel was repaired via an open approach, and bowel was reduced without need for resection. The decision was made to allow time for the bowel to decompress before undergoing repair of the fat-containing hernia later. The patient recovered appropriately and was discharged on post-operative day two. A few months later, she underwent elective laparoscopic mesh repair of the other lumbar hernia with no post-operative complications.
Conclusion: Clinical suspicion must remain high for lumbar hernias being the root cause of a patient presenting with signs of bowel obstruction. When discovered, symptomatic lumbar hernias should be repaired promptly to reduce viscera, if present, and to avoid bowel strangulation. Given the rarity of bilateral lumbar hernias, especially with bowel obstruction, there is no consensus on the best management modality. Both open and laparoscopic repairs have been found to be safe and effective for the treatment of lumbar hernias. The optimal approach should be tailored to the patient’s presentation and comorbidities as well as the surgeon’s expertise. It may be appropriate to undergo a stepwise approach to surgical repair to address emergent risk of strangulation first, and electively repair the other lumbar hernia later.

Published on: May 18, 2023
doi: 10.17756/micr.2023-089
Citation:  Koerner AS, Lopes JM, Lopes JA, Duggan EM. 2023. Bilateral Lumbar Hernias with an Associated Large Bowel Obstruction: A Case Report. J Med Imaging Case Rep 7(1): 19-22.

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