Recurrent bilateral lumbar hernia, a case report and literature review

Abstract

Lumbar hernia is a rare condition characterized by protrusion of retroperitoneal contents through a defect in the posterolateral abdominal wall, with fewer than 400 cases reported. Bilateral lumbar hernia is exceedingly rare, and recurrence following surgical repair is even more uncommon. We report a case of a 44-year-old male laborer with recurrent bilateral lumbar hernia who initially presented with bilateral reducible lumbar swellings which were successfully diagnosed as bilateral lumbar hernia and underwent surgical repair using mesh reinforcement. The hernias recurred four months postoperatively, and the patient presented again 2.5 years later. This time, he also experienced lumbosacral back pain with radiation to the right foot. Clinical examination and imaging, including ultrasound and CT scan, confirmed bilateral lumbar hernia recurrence. The patient declined further surgical intervention, opting for conservative management. MRI of the spine also revealed L4/L5 and L5/S1 disc herniations, and a Tarlov cyst. This case highlights the diagnostic and management challenges posed by recurrent bilateral lumbar hernia, particularly in resource-constrained settings. It also highlights the potential coexistence of unrelated spinal pathology, which may complicate symptom interpretation. We review the existing literature and discuss potential risk factors for recurrence, including suboptimal mesh fixation, and the importance of individualized surgical planning. Awareness of this rare condition is crucial for prompt diagnosis and appropriate management.