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Concurrent Spigelian and Grynfeltt-Lesshaft Hernias.
Ryan M Huttinger1, Matthew S Kazaleh2, Dylan J Skinner1
1Department of Surgery, 3343Cape Fear Valley Medical Center, Fayetteville, NC, USA.
The American Surgeon
|November 17, 2021
Summary
Spigelian and Grynfeltt-Lesshaft hernias are rare, intermuscular hernias often missed on physical exam. A case highlights their diagnostic challenges and potential for bowel obstruction.
Area of Science:
- Gastroenterology
- Surgical Anatomy
- Abdominal Wall Surgery
Background:
- Spigelian hernias (0.12%-2% of diagnosed hernias) occur along the Spigelian fascia.
- Grynfeltt-Lesshaft hernias occur within the superior lumbar triangle.
- Both are intermuscular, making them difficult to diagnose due to concealment.
Observation:
- An 86-year-old male presented with symptoms of small bowel obstruction.
- Physical exam revealed a right lower quadrant hernia and a right posterior flank mass.
- Computed tomography confirmed bowel incarceration in a Spigelian hernia and an additional Grynfeltt-Lesshaft hernia.
Findings:
- The patient underwent successful Spigelian hernia repair with synthetic mesh.
- The asymptomatic Grynfeltt-Lesshaft hernia was deferred for later repair.
- Concurrent Spigelian and Grynfeltt-Lesshaft hernias are exceptionally rare.
Implications:
- These rare hernias present diagnostic challenges due to low incidence and subtle physical findings.
- Clinicians must maintain high suspicion for these hernias in patients with unclear abdominal symptoms.
- Timely diagnosis and management are crucial to prevent complications like bowel incarceration.
