Lenticular Loop

Introduction

**Lenticular loop** is a fibromuscular pouch located between the left rectus abdominis muscle and the left lumbar fascia in the middle part of the peritoneum. This rather rare variant of the hernial sac is one of the abnormalities of the abdominal wall, which can be a functional or non-functional hernia. The most common and common are indirect inguinal and femoral hernias. There are also bilateral inguinal hernias, direct femoral hernias, and hernias of the pubic tubercle. And only in 1% of cases does a hernia occur in the pelvic area. And it is not at all often possible to find a lenticular loop as an anatomical element of the posterior abdominal wall. Moreover, in relation to the peritoneal process, it can be either isolated or its continuation. The lentil loop manifests itself as a hernia in any part of the abdominal cavity. From the Latin “fascia transversalis” - the posterior peritoneal membrane was named after the shape of the defect - “lentil”.

The concept of the lentil loop was introduced by the German anatomist Samuel Ewald in 1918. This is one of the subtypes of congenital abdominal hernias, which makes up 3-4% of all other forms of hernial protrusions. Despite the fact that the loop of lentils is mainly located behind the navel, it is also found under the right inguinal ligament. Rarely, these protrusions occur around the bladder.

Pathological anatomy and classification

A lenticular loop is a formation on the anterior surface of the abdominal wall at the level of the 2nd lumbar vertebra, on the lateral wall of the abdomen. At the site of a lenticular hernia, a small defect occurs in the posterior layer of the sheath of the rectus abdominis muscle, directly near the aponeurosis with a gradual transition to another abdominal wall. The cartilaginous septum determines the shape, size and position of this neoplasm, similar to a pouch or purse. Firmly fixed intraperitoneally, such a bag fills the gap between the peritoneum and the umbilical canal. Accordingly, there is no external passage, and decay products of the body in the form of feces and blood accumulate inside the hernia. Its contents sometimes do not exclude intestinal loops from entering the abdominal sac. Due to the constant accumulation of contents in a lenticular hernia, inflammation, skin irritation, folds and dilated veins, an increase in width and the release of necrosis material occur. The contents of the lentil loop are prone to up and down movements when the body position changes or the contents are squeezed outward. The volume of contents is up to three liters in each class of lentil hernias. In old age it decreases. The pain and contents of the lenticular loops are usually moderate and do not affect the patient's daily life. Most patients who are first diagnosed with lenticular hernias discover an incidental finding during abdominal examination in patients complaining of abdominal pain or during upper genitourinary examination, such as BPH or cystoscopy. The admixture of blood in the contents of the lenticular sac is manifested by the presence of a corresponding odor upon opening