[Post-traumatic lumbar hernia and abdominal wall reconstruction technique. A case report]

Little less than half of the occurrences acquired lumbar hernias are caused by traumatisms: direct parietal contusions, iliac crest biopsies or fractures. Regarding their frequency, they are rare but generally underdiagnosed. Abdominal wall reconstruction is motivated by the risk of hernia strangulation, but also aims to rebuild continent abdominal muscles, allowing the loss of discomfort or worsening risk as well as to resume physical activities.

We report a case of parietal reconstruction of a traumatism-induced lumbar hernia in a 59-year-old male patient. Scanner showed lumbar disinsertion of abdominal transversus and both obliquus externus and internus muscles. The pressure exerted on abdominal muscles, greater than the elastic resistance of the insertion aponeurosis, caused their tearing. The flexibility and elasticity of the skin allowed the sustainment of its integrity. We applied Welti-Eudel's technique to suture the dorsal edge of the transverse and oblique intern muscles with a flap coming from lumbo-dorsal fasciae of sacrospinalis muscles. A parietal prosthesis is inserted between this deep level and the obliquus externus, which is restored.

Fifteenth month's results, both morphological and functional, are excellent. Check scanner shows anatomical restitution of abdominal muscles.

The scanner of abdominal muscles is the leading complementary exam. It is repeated with a gap, so that the hematoma does not disturb its interpretation. Surgical indication is definite for active adults. Parietal prosthetic strengthening, bone inserted between two muscular levels, avoid late loosening. It has no immediate mechanical value, which is secured by abdominal girdle during healing.