CORRESPONDENCE

Petit's Hernia: a case report^* * Work done at ABC School of Medicine - Prof. Dr. Luiz Henrique Camargo Paschoal Skin Institute - Dermatological Surgery Service - Santo Andre-SP, Brazil.

Maurício Zanini^I; Fábio R. Timoner^II; Carlos D'Aparecida Machado Filho^III

^ISpecialist in Dermatology, resident in Dermatological Surgery, member of the Brazilian Society of Dermatology and Surgical Dermatology

^IISpecialist in Dermatology, assistant professor, member of the Brazilian Society of Dermatology and Surgical Dermatology

^IIIActing Head of the Discipline of Dermatology, FUABC, doctor of Dermatology

^{Correspondence} Correspondence to Maurício Zanini Rua Vicente de Carvalho, 198 09060-590 Santo André SP Tel.: (11) 4992-7724 E-mail: drzanini@terra.com.br

Male patient, white, 36 years old, industrial worker, resident in Santo André, State of São Paulo, sought medical attendance at the service complaining of a "lump" in the back which had appeared over 10 years ago. The lesion was asymptomatic, and its size had been increasing progressively since onset. He denied any history of local trauma. Physical exam showed an ovoid tumor in the right inferior lumber triangle, measuring 10cm x 8cm, it was not very mobile and had a firm and elastic consistency (Figure 1). It could not be compressed and on Valsalva maneuver, there was a slight tendency for it to increase in size. The patient was submitted to ultrasonography with a diagnostic hypothesis of lipoma. The exam showed a protrusion of the dorsal fibromuscular wall containing adipose tissue. A diagnosis of Petit's hernia was established and the patient was referred to the general surgery service.

A hernia is an abnormal protrusion of tissue or an organ from one anatomical site to another through a natural hole or defect in the fibromuscular septum. The majority of hernias occur in the anterior abdominal wall and particularly in the inguinal region. However, other places can be involved, such as the femoral, umbilical, lateral abdomen and lumbar regions.¹

The lumbar or dorsal hernia is rare and occurs due to a defect in the fibromuscular fascia of the posterior wall of the abdomen.² Up until 1995, only 300 cases of lumbar hernias had been reported in the literature.³ The lumbar hernia occurs basically in two places: in Grynfeltt's triangle or in the superior lumbar triangle and in Petit's lumbar triangle.² Grynfeltt's hernia is more common than Petit's hernia.³ It can be acquired or congenital. The congenital form usually appears in childhood,² and can be an isolated phenomenon or associated with congenital/hereditary anomalies, such as the syndrome of lumbar vertebral deficiency, meningocele and neurofibromatosis.^4,5 Acquired lumbar hernia can be primary or idiopathic and secondary (surgery, closed or open trauma).^2,6

Petit's hernia usually affects young and athletic women. The patient's main complaint being the perception of a tumor with firm consistency in the back, which can be accompanied by a burning sensation or pain. Imprisonment and strangulation occurs in 10% of the cases. The hernial content is usually composed of fatty tissues, however visceral structures can be present. The size of the lumbar hernia develops progressively, and as such, whenever it is diagnosed surgical treatment is indicated, which consists of the reconstruction of the defective wall.^1,6 The differential diagnosis should include intracavitary tumors (renal tumor), muscular contracture, soft part tumors (including lipoma), hematoma and abscess.^1,2

The objective of this correspondence was to emphasize the importance of a holistic medical knowledge, as well as the salutary application of complementary exams whenever appropriate. If on the basis of clinical findings alone, which gave a strong diagnosis of lipoma or soft part tumor, the patient described had been referred to surgery as such, the result could have been disastrous. q

REFERENCES

Received in October, 08^th of 2002

Approved by the Consultive Council and accepted for publication in October, 08^th of 2002

Publication Dates