eP582 - "Recurrent Colonic Diverticulum Inflammation Associated with Lumbar Hernia: Optimal Management and Clinical Implications"

Monday, June 3, 2024

10:18 AM – 10:23 AM ET, USA

Location: Baltimore Convention Center, Room 318-320

ePoster Presenter(s)

Bakhtawar Mushtaq, MD

Resident
Abington Jefferson health
Abington Jefferson Health
Abington, PA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

Gabrielle Perrotti, MD (she/her/hers)

Resident
Abington-Jefferson Hospital
Abington-Jefferson Hosptial
Wyncote, PA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Michael S. Gerges, DO

Resident Physician
Jefferson Northeast/Philadelphia College of Osteopathic Medicine
Philadelphia College of Osteopathic Medicine
Newark, DE, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
JO

Jesse C. Ottaway, MD

Resident
Jefferson Abington Hospital
Horsham, Pennsylvania, United States

Disclosure information not submitted.

Senior Author(s)

SN

Seth L. Newman, MD

Assistant Clinical Professor of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University
FACS
Abington, Pennsylvania, United States

Disclosure information not submitted.

Purpose/Background: Diverticulitis arises from acute inflammation within the diverticulum due to the micro or macro perforation of the colonic diverticular wall. It has been considered as one of the most common colonic pathologies requiring hospital admission. Lumbar hernia results from posterolateral abdominal wall defect with only 300 cases in literature. The co-occurrence of recurrent diverticulitis due to a lumbar hernia is an exceedingly unusual phenomenon. We present a case of recurrent colonic inflammation in a patient secondary to an incarcerated diverticulum in a left lower lumbar hernia.Methods/Interventions: An 87-year-old Caucasian female with a history of recurrent uncomplicated diverticulitis presented to the ER with left flank pain associated with nausea. She was afebrile and had no leukocytosis. Computed Tomography of the abdomen and pelvis revealed a left superior lumbar hernia containing a segment of the left colon which had a large, inflamed diverticulum inside the hernia sac. She was discharged on oral antibiotics. She was scheduled for elective repair of robot-assisted laparoscopic repair of lumbar hernia after the resolution of diverticulitis.Results/Outcomes: She was placed in the right lateral decubitus position. Abdominal access was achieved at Palmer’s point with a Veress needle. Intra-operative findings were significant for incarcerated, non-strangulated descending colon containing lower lumbar hernia with three adjacent fascial defects for a total fascial length of 4 cm. Her hernia contents were reduced and repaired primarily followed by a permanent extraperitoneal mesh placement to reinforce the repair. The patient had no complications perioperatively and was discharged the same day.Conclusion/

Discussion: The occurrence of recurrent colonic inflammation resulting from colonic diverticulum incarceration within a lumbar hernia is an infrequent event. Optimal management involves hernia repair to prevent future episodes of inflammation and subsequent colectomy."CT scan findings of incarcerated left colon in left inferior lumbar hernia

Saggital Cut
Intra-operative findings of primary repair of lumbar hernia with mesh reinforcement.

intra-operative
Intra-operative findings of Closure of peritoneal flap over the mesh.

Intra-operative"