Flank Hernia

Flank and lumbar hernias are rare and often diagnosed on the basis of clinical suspicion or diagnostic imaging. Computed tomography (CT) imaging is the gold standard for diagnosis. Magnetic resonance imagery (MRI) has questionable utility, and ultrasound can be used as an adjunct, as it is for ventral and incisional hernias [the DASH (dynamic abdominal sonography for hernia) method]. Despite its applicability, there is currently no standardized method for using ultrasound to diagnose flank and lumbar hernias. Clinical suspicion for a hernia often guides patient selection for further imaging and evaluation. Alternatively, the diagnosis can be made during routine screening for other diagnoses such as abdominal pain, bowel obstruction, or trauma. Overall, flank hernias comprise a small percentage of abdominal wall hernias. When suspected, ultrasound [the LAFS (lumbar and flank sonography) method] may be employed as a screening method; however, CT scanning is recommended to evaluate relevant anatomy and for operative planning. When diagnosed, flank and lumbar hernias should be repaired, but the details of repair are beyond the scope of this chapter.