Laparoscopic management of a traumatic lumbar hernia: about a case

Traumatic Lumbar hernia (TLH) is a very rare clinical entity with about 100 cases reported worldwide. It is a difficult challenge when encountered and there is no consensus on the best management: early or delayed, open or laparoscopic.
We report the clinical case of a 28-year-old man who suffered from a TLH after a 6- meter-high fall. The diagnosis was based on CT imaging showing a defect in the postero-lateral abdominal wall by disinsertion of the lumbar origin of transverse, internal and external oblique muscles. A few months after the trauma, it became gradualy more painful, the hernia was clinically increased with a large swelling on the right flank majored by valsalva. CT imaging showed herniation of the right colic flexure through the defect.
Eight months after the trauma, we performed an intra-abdominal laparoscopic approach. Herniated structures were reduced and we opened the peritoneum. The defect was repaired by placing a pre-peritoneal polypropylene mesh fixed by laparoscopic staples before closing the peritoneum. The patient had an uneventful recovery. Ten weeks after the surgery the result was clinically very good. The CT scanner showed a good recovery of parietal continuity.