The authors report that in 25% of the excised lumbar fatty hernias -hernias grasas con lesiones necróticas- (back mice) from patients with lumbago they found necrotic lesions. They present this brief note (written in Spanish) to show it and to promote attention about it. However, they endeavor to publish a more complete paper that emphasizes the importance and frequency of this condition in spite of being scarcely known.

They present 4 photos as graphic information from the macroscopic findings of the excised fatty hernias – hernias grasas con lesiones necróticas – from patients that presented the cure of lumbago after surgical removal.

The objective of the authors seems to be to CONVINCE the medical community that the fatty hernias (back mice) are a REAL entity. In most of the fatty hernias, the only pathological finding is EDEMA (which does NOT impress the colleagues). They think that the necrotic lesions will be more convincing. They admit that, two years before, even they themselves were unaware of this entity and maybe they missed it in many patients.

About the authors:

Argentinian doctors. They had previously published about it in an article in “Semana Médica” in 1949.

Authors’ statement:

“En nuestro ambiente se sigue dudando de la existencia del cuadro señalado, razón por la cual juzgamos que esta breve y previa comunicación ha de interesar a los que aceptan y conocen porque los confirmará en sus ideas y, por otra parte, impulsará a buscarlo y estudiarlo en el futuro a todos aquellos que aún no tienen experiencia propia formada.”

They state that many colleagues still doubt of the existence of the fatty hernias (back mice), their hypothesize that by showing that in some of these fatty hernias (25%) there are NECROTIC lesions, some colleagues will get the interest on it.

La frecuencia de las hernias grasas con lesiones necróticas como causa de lumbago

[The Frequency of Fatty Hernias with Necrotic Lesions as a Cause of Lumbago]

By H. Dal Lago and A. Vera

The doctors start talking about 3 entities related to lumbago and lumbosciatica:

–The fatty hernias or painful lipomas

–The “myofascial syndromes”

–The fibrositis

They say that they are COLLECTING many anatomic specimens from the lumbar area to get much information about this still unknown entity. As a part of their project, they present this SHORT article to show some of the macroscopic findings of the excised fatty hernias (back mice) from patients that suffered from lumbago.

-They found NECROTIC LESIONS in 25% of the operated hernias.

The rest of the lesions correspond to a FATTY LOBULE WITH AN INTENSE EDEMA that makes it HARD, PROTRUDING and SHINING.

They want to make clear that the “hernia grasa lumbosacroiliaca dolorosa” – the lumboscacroiliac painful fatty hernia – IS NOT a rare entity, on the contrary, they found it to be a frequent cause of lumbago.

Dal Lago and Vera want to CONVINCE the medical colleagues by showing the necrotic lesions in some of the fatty hernias they remove

They suspect that the photos from the edematous fatty lobules are not very convincing, but they presume that the photos from the NECROTIC LESIONS in some of this fatty hernias would be much more convincing that this is a “real” entity.

Other authors do not mention necrotic lesions

They mention the previous works from Copeman and Ackerman (1947) and Carbonell Antolí (1945) about fatty hernias and lumbago. Also the work from their colleague Américo NUNZIATA, who published about the fatty hernias but without the finding of OBVIOUS MACROSCOPIC NECROTIC lesions.

They admit that 2 years before they were unaware of this type of lesions and also the entities of “myofascial syndrome and fibrositis”. Now they are studying them.

Controversial surgical results after fatty hernias removal

They admit that it is necessary to study this entity more, since they have sometimes not good results and some other times excellent outcomes.

In some of the first cases that they operate and excised that fatty hernia, the pain persisted. They could observe that some of those patients for whom the pain persisted had associated the fibrositic syndrome or myofascial syndrome. BUT THEY MAKE IT CLEAR that the aim of this article is not about going deep over that. So they do not explain any further.

MICROSCOPIC FINDINGS of the fatty hernias (back mice)

They differentiate 2 states:

AN EARLY STAGE: with EDEMA from the fatty lobule. That edema makes the fatty lobule appear “HARD, protruding y shining”. This is very obvious once the skin and the superficial fascia are cut and the tense fatty lobule appears. Once they excise the fatty lobule, this IMMEDIATELY loses tension, desedematizes, and gets smaller and shrinks. They could not show photos from that.

–A LATER STAGE:

-In 2 occasions after cutting the fatty lobule, they found a SIMPLE CAVITY with a white thick liquid product from ESTEATO NECROSIS simple from the fatty tissue necrosis.

-If the stage proceeds, then the appearance is from a LIPOPHAGIC GRANULOMA sometimes with a clear cavity formation.

Published in October 2018 By Marta Cañis Parera    

References

Dal Lago H. Y Vera A.. La frecuencia de las hernias grasas con lesiones necróticas como causa de lumbago. Revista DE ORTOPEDIA y TRAUMATOLOGIA /Buenos Aires). 1950. 20 p160-164. ISSN: 1669-5860.