Traumatic lumbar hernias: Difficulty with diagnosis and repair

Infrequently encountered, the traumatic lumbar hernia presents a challenge to the surgeon both in diagnosis and management. Repair is often complicated by a lack of viable fascia and a high incidence of associated injuries. The following review considers the natural history of lumbar hernias and their etiologies. Subsequently, the role of computed tomography (CT) in diagnosis is discussed. Finally, the multiple techniques of repair are presented, along with a discussion of the role of laparoscopy. Two case reports of traumatic lumbar hernias are presented, followed by a review of the literature and discussion. The case reports include a 36-year-old bicyclist who was thrown into a fixed roadway object and a 44-year-old victim of a side impact motor vehicle crash. The 36-year-old bicyclist underwent open repair with polytetrafluoroethylene (PTFE) and has done well at 7-month follow-up. The 44-year-old victim of a motor vehicle crash underwent open primary repair and has done well at 36-month follow-up. Traumatic lumbar hernias require a high index of suspicion in order to avoid the potential for incarceration and missed associated injuries. CT is helpful in making this diagnosis. Principles of hernia repair including freedom from tension and avoidance of compromised fascia are vital. Additionally, a thorough evaluation for associated injuries is paramount. Mesh should be used liberally and laparoscopy offers some advantage in the hands of the experienced.