Traumatic lumbar hernias, when should I operate? A case report

Traumatic lumbar hernias are a rare subset of abdominal wall hernias encountered following blunt trauma to the abdomen. These are more commonly being found due to the increased use of advanced imaging. Three cases of traumatic lumbar hernias were identified at our institution from 2021 to 2022, one of which underwent delayed repair. The second case resulted in the resolution and healing of the defect within 6 weeks of presentation, and the third was lost to follow up. Acute repair of lumbar hernias might be indicated during the repair of other intra-abdominal injuries. Delayed repair allows for a laparoscopic approach or open repair via flank incisions. Delay in asymptomatic patients may also result in fibrosis and scarring and may resolve the defect. Fixation of mesh to adjacent bony structures may be needed, and adequate sub-lay dissection for mesh placement particularly for larger defects. Consider delaying the repair of traumatic lumbar hernias in asymptomatic to minimally symptomatic patients if no other abdominal surgery was warranted at the time of presentation.