The iliac crest is a common donor site for autogenous bone grafts. Although a bone graft can be harvested relatively simply, the surgeon should be aware of the potential morbidity. A reported complication is herniation of abdominal organs through the iliac crest defect.

We present a 55-year-old white male with asthma and an incisional iliac hernia. A bicortical bone graft 2.5 x 3-cm was harvested from the left iliac crest one year ago. The patient presented with a left flank bulge and pain. A hernia was present over the left iliac crest extending to the lateral abdominal wall. Computerized tomography with contrast confirmed a large bowel herniation in the region of iliac bone resection. In the operating room a defect 7-cm in diameter was found through the transversalis and internal oblique muscles contiguous to the iliac crest defect. The hernia sac was reduced and the defect was repaired with a large size oval Kugel mesh placed in the preperitoneal space. The mesh overlapped the iliac bone and the lateral abdominal muscles thus covering the hernia defect. The patient was free of symptoms and there is no recurrence in a three-month follow-up.

Hernias of the lumbar region are rare but have been reported to occur after trauma, flank surgery, iliac bone grafting, spontaneously, or as a result of congenital abnormality of musculoskeletal development. An incidence of 5% has been reported after iliac bone graft harvest. The onset of herniation symptoms is variable. The contents of the hernia may be retroperitoneal fat, kidney, small or large bowel and spleen. Computerized tomography is the only radiographic procedure required for an accurate diagnosis. Most authors recommend repair with a synthetic mesh. If a full thickness bone graft is harvested precise and careful closure should follow to prevent herniation.