Anterior lumbar hernia in a neonate

A full-term neonate presented at birth with a left lateral abdominal wall mass that was not identified on routine prenatal ultrasound. An initial postnatal ultrasound obtained prior to paediatric surgery consultation failed to demonstrate a discrete fascial defect. On physical examination, a prominent left lateral abdominal wall bulge was noted, particularly during straining. With the infant at rest, a palpable fascial defect was appreciated at the level of the left anterior lumbar region, consistent with a variation of a congenital lumbar hernia. The patient otherwise appeared well and was discharged home with outpatient follow-up arranged. Elective surgical repair was performed at 2 months of age. The hernia was repaired in three layers with an AlloDerm (Allergan Aesthetics, AbbVie Inc, Chicago, IL, USA) graft placed in a sublay position between the two fascial layers. The infant tolerated the procedure well, and there has been no evidence of recurrence at follow-up.