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Superior lumbar hernia of Grynfellt
  1. A Pitale,
  2. V Laughlin
  1. Lagan Valley Hospital, Hillsborough Road, Lisburn, Co Antrim BT28 1JP, UK; ashishpitale{at}lycos.com

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    A 44 year old woman was investigated for a soft, non-tender, reducible swelling, measuring 5 cm in diameter in her left lumbar region. There was no cough impulse. An abdominal computed tomogram revealed a superior lumbar hernia, first described by Grynfellt. The hernial content was retroperitoneal fat from around left kidney, which had prolapsed through the transversalis aponeurosis. The external oblique (1), internal oblique (2), and the transversus abdominis (3) lie anteriorly (see fig 1). The erector spinae (ES) forms the posterior boundary. The superior border is formed by the 12th rib and the iliac crest forms the inferior border. The defect was repaired using interrupted non-absorbable sutures after retracting the latissimus dorsi. The patient has been followed up for a period of 16 weeks and there has been no recurrence.

    Superior lumbar hernia is rare and may easily be misdiagnosed as a lipoma if a strong index of suspicion is not kept.

    Figure 1

    Abdominal computed tomogram showing superior lumbar hernia (SLH). LK, left kidney; PR, perirenal fat passing through transversalis aponeurosis to form SLH (arrowed); ES, erector spinae; LD, latissimus dorsi. (1) External oblique, (2) internal oblique, (3) transversus abdominis.

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