PMC7265045_01
Physical and radiologic images of the right superior lumber hernia. (a) Physical findings in the standing position. (b) Computed tomography imaging showing right superior lumbar hernia. (a) A reducible bulge in the right upper back can be seen (arrows). (b) Herniation in the right superior lumbar space. The hernia is assumed to contain the ascending colon (arrowheads).
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The patient had noticed an enlarging bulge in mid aspect of the right back, which was about the size of a tennis ball but was easily reducible (Fig. 2a). Computed tomography revealed the hernial orifice to be on the lateral side of the right quadratus lumborum just causal to the costal arch (Fig. 2b).
Intraoperative findings and surgical approach to repair the right superior lumber hernia. (a-c) Intraoperative findings and (d) Schema of open approach hernioplasty for right superior lumbar hernia indicating the location of the underlay mesh inserted. (a) The hernia sac is identified within the latissimus dorsi on the back. (b) Ileal and cecal tissue contained in the hernia is adherent to the hernia sac. (c, d) A mesh underlay is inserted between Zuckerkandl's fascia and preperitoneal fascia.
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The latissimus dorsi was then mobilized from the lateral side, and the hernia sac was detected in the posterior aspect of the muscle (Fig. 3a). The content of the hernia was the ileocecum, which was extensively adherent to the hernia sac (Fig. 3b). After repositioning the hernia sac and its contents within the abdominal cavity, polypropylene mesh (Ventrio  Small Oval Hernia Patch, Bard Medical, Covington, GA) was inserted between the internal oblique and Zuckerkandl's fascia to prevent herniation of the preperitoneal organs (Fig. 3c, d); the mesh was fixed quadratus lumborm using two sutures to avoid dislocation.