Beyond the Diaphragm: Grynfeltt-Lesshaft Hernia Presenting With Small Bowel Obstruction.

Lumbar hernias are uncommon defects of the posterolateral abdominal wall and may be difficult to distinguish from other thoracoabdominal abnormalities because of their location and variable appearance on imaging. Superior lumbar, or Grynfeltt-Lesshaft, hernias are particularly rare causes of acute bowel obstruction. We report the case of a 51-year-old man with obesity and chronic cough who presented with abdominal pain, vomiting, obstipation, dyspnea, and right flank ecchymosis. Computed tomography (CT) obtained before hospital transfer demonstrated herniated small bowel in the right posterolateral thoracoabdominal region, which was concerning for a closed-loop obstruction from a diaphragmatic hernia. Emergent exploratory laparotomy instead demonstrated an intact diaphragm, with a 5-cm defect in the right superior posterolateral abdominal wall immediately inferior to the twelfth rib containing the incarcerated small bowel. The findings were consistent with a superior lumbar hernia. The bowel was viable following reduction, and the defect was closed primarily. This case highlights the diagnostic challenge of superior lumbar hernias and the importance of durable reconstruction when feasible, particularly in patients with factors that may increase intra-abdominal pressure or the risk of recurrence.