The document discusses the anatomical characteristics of the lumbar triangle, also known as Petit’s triangle, and its relevance in surgery, particularly concerning hernias. Jean-Louis Petit, a French surgeon, is highlighted for his contributions to anatomy and surgical techniques. The document covers the boundaries of the triangle, types of lumbar hernias, treatment methods, and the triangle's surgical significance.

1. Theme:
«Lumbar triangle(Petit’s
triangle) and it’s anatomical
characteristics»
Done By: Myrzakhanov Yerik
4course GMF 451 group
Check By: Aldyngurov Daulet
Kadirovich
Semey 2014

2. Plan:
 Introduction. Jean Louis Petit
 Petit triangle, boundaries
 Lumbar hernia, Treatment
 Surgical significance
 List of references

3. Introduction
 Jean-Louis Petit (13 March 1674 – 20 April 1750)
was a French surgeon. He was first enthusiastic
about anatomy, received a master's certificate in
surgery in Paris in 1700. He became a member of the
French Royal Academy of Sciences, and was named
director of the French Royal Academy of Surgery by
the king when it was created. Offered ways of hernia
repair, enterography, amputations; invented a variety
of tools and devices (such as a tourniquet, the unit for
the treatment of foot deformities).

4. Introduction
 His name is associated the name of the lumbar
triangle (trigonum lumbale Petiti). Also wrote about
the injuries of the skull, the treatment of cleft lip,
gallstones, and many other issues in surgery.
 Known for his work on the Achilles tendon rupture,
dislocation of the jaw, he first described about
osteomalation. Just the first to describe the relaxation
of the diaphragm , implying that the notion of
complete relaxation domes and its high standing.

5. Boundaries (borders) of
lumbar triangle
 The triangle of Petit
(trigonum lumbale, PNA,
BNA, JNA; syn .: Petit triangle
lumbar triangle) – site of the
posterior abdominal wall.
Bounded above and medial
with tendon node latissimus
dorsi, and laterally and left
back edge of the external
oblique muscle of the
abdomen, extending from the
XII rib, below with the iliac
crest, the bottom is the
internal oblique and
transverse abdominal
muscles.

7.  The initial division of the latissimus dorsi muscle
(as well as the site of attachment of the external
oblique abdominal muscles to iliac crest) is divide
to individual differences, so the shape of the
lumbar triangle changeable. It resembles a narrow
hole between the edges of forming his latissimus
dorsi and external oblique abdominal muscles.
According by P. F. Lesgaft, lumbar triangle is
found only in 75% of people.

8.  External view

10.  The bottom of the triangle is the internal
oblique muscle, covered by fascia, weakness
which may cause the appearance of lumbar
hernia.

11. Lumbar hernia
 Lumbar hernia(h. Lumbalis) - hernial protrusion on
the back and side walls of the abdomen in the
lumbar region. They are congenital and acquired
(traumatic, muscle atrophy and etc.).
 Place their output is lower and upper lumbar
triangles between the XII rib and the iliac crest to
the lateral edge of the latissimus dorsi muscle (m.
Latissimus dorsi), as well as defects in the
aponeurosis without specific localization due to
rupture or inflammation.

12.  Hernial ring at the lower lumbar hernia are
within the lower lumbar triangle (Petit).
 Hernial ring at the upper lumbar hernia are
within the upper lumbar triangle (Grynfeltt-
Lesshaft)*. The base of the triangle, the apex
facing down is the transversus abdominis, the
outside is covered with a broad back muscles.

13. *
 The superior lumbar (Grynfeltt-Lesshaft)
triangle is formed medially by the quadratus
lumborum muscle, laterally by the internal
abdominal oblique muscle, and superiorly by
the 12th rib. The floor of the superior lumbar
triangle is the transversalis fascia and its roof
is the external abdominal oblique muscle.

15.  The mostly, the contents of a typical lumbar
hernia is small intestine, while sliding hernia -
ascending or descending colon. Often lumbar
hernia have no hernia sac, and through the
hernial ring out retroperitoneal fat, sometimes
kidney. In this case, the hernia will be false.

17. Treatment
 Surgical - resection of the hernial sac, closure
of hernial ring, the reconstruction of the
transversal abdominal muscles. When lumbar
hernia with large hernial ring used to close the
defect synthetic materials or muscle flaps.

18. Surgical significances of triangle
of Petit
 At peritonitis abdominal establish drainage
through lumbar triangles of Petit by a cross-section
of the skin, subcutaneous tissue,
superficial fascia and private over the iliac crest at
the intersection, with its posterior axillary line, with
a further dislocation of internal oblique abdominal
muscles in the course of its fibers and introduce of
all drainages on the parietal peritoneum posterior
wall of the abdominal cavity in the mesenteric
sinuses under the root of the mesentery of the
transverse colon.

19. Surgical significances of triangle
of Petit
 Symptom Joure-Rozanov - pain when finger
pressure in the triangle of Petit. Used in the
diagnosis of acute appendicitis. In that case
peritoneum in this department is relatively
superficial.

20. Surgical significances of triangle
of Petit
 At retrocecal appendicitis in this area can be
detected positive symptom Gabai – the sharp
increases of pain when palpated quickly
remove your hands after pressing, as the
symptoms of Shchetkina - Blumberg.

21. Surgical significances of triangle
of Petit
 Extraperitoneal laparoscopic approach to
the adrenal glands.
 In the angle between the rib XII and
sacrospinous muscle (m. Sacrospinalis) (the
so-called triangle of Petit) performed a cut
length of 15 mm. In this incision the surgeon
can accurately enter your finger to create
access to the retroperitoneal paranephral
space.

22. List of references:
 Анатомия человека: В 2 томах / Под ред.
М.Р.Сапина. – М.: Медицина, 1997.- Т.1.- 544 с.
 http://en.wikipedia.org/wiki/Jean_Louis_Petit
 http://en.wikipedia.org/wiki/Lumbar_triangle
 Aguirre DA, Santosa AC, Casola G et-al. Abdominal
wall hernias: imaging features, complications, and
diagnostic pitfalls at multi-detector row CT.
Radiographics. 2005;25 (6): 1501-20.
 MILLARD DG. A Richter's hernia through the inferior
lumbar triangle of petit. A radiographic demonstration.
Br J Radiol. 1959;32 (382): 693-5
 Большаков О.П., Семенов Г.М. Лекции по
оперативной хирургии и клинической анатомии. –
СПб.: Питер, 2000. – 480 с.