Abdominal intercostal hernia and costal arch repair

A 70-year-old asthmatic man presented with a history of chronic intermittent left-sided chest pains and a bulge-like deformity of his chest which became more prominent with expiration. He sustained a traumatic fall 2 years prior whereby he fractured his right humerus at the surgical neck, requiring total arthroplasty. Examination and CT imaging of the thorax revealed a left costal arch fracture with hemidiaphragm rupture and associated transperitoneal fat herniation. He underwent left thoracolaparotomy with costal arch and diaphragmatic hernia repair. He was discharged 48 hours postoperatively and is satisfied with good outcomes under initial follow-up. This case report highlights the surgical management of a condition that usually presents late after significant trauma and may progress to visceral strangulation if untreated.

P039 INTERCOSTAL HERNIA FOLLOWING DIEP RECONSTRUCTION: A CASE PRESENTATION

Aim Intercostal lung herniation is a rare clinical condition defined as the protrusion of lung parenchyma beyond the anatomic boundaries of the thoracic wall. Acquired lung hernias are typically occur secondary to trauma or are associated with severe pulmonary disease. We present a case of lung herniation following DIEP breast reconstruction which is the first reported case to date. Material and Methods 40-year-old woman with a history of bilateral mastectomy for breast cancer and subsequent delayed, bilateral DIEP breast reconstruction. She returned to the emergency department four days after her reconstruction with chest pain, shortness of breath and swelling of her chest. CT angiography of her chest demonstrated a focal protrusion of her right lung into her anterior chest wall (Figure 1). Thoracic surgery was consulted for repair which was achieved with a patch technique using Allomax dermal matrix. Results We describe the first reported intercostal lung hernia following DIEP breast reconstruction reported in scientific literature. Our patient had no history of trauma, thoracic surgery or pulmonary disease which are considered the greatest risk factors for acquired intercostal lung herniation. Much like abdominal wall hernias, protrusion of tissue through a small defect places tissue at risk for ischemia. Early recognition is thus essential to avoid tissue loss. Conclusions Intercostal lung hernia is an uncommon clinical entity that has not previously been described as a complication of DIEP breast reconstruction. Its development is associated with significant morbidity including flap loss in this case. Early recognition of this rare complication is essential to avoid more severe sequelae of tissue ischemia.

Laparoscopic repair of transdiaphragmatic intercostal hernia following blunt trauma

Background Transdiaphragmatic intercostal hernia (TIH) is a rare clinical entity that generally occurs following trauma or surgical intervention, but it may occur spontaneously Case Report An 82-year-old Korean man presented with left-sided chest pain after falling off an agricultural vehicle. Physical examination revealed a bruised painful swelling in the left lower chest wall confirmed as hernia of the transverse colon and omentum through a defect in the diaphragm into the 7th intercostal space. Laparoscopic repair with a prosthetic mesh was successful with no sign of hernia recurrence 3 years after injury. Discussion TIH is uncommon. Depending on the associated injuries they may be repaired via the chest or abdomen and with the widespread advent of minimally invasive surgery this can be achieved laparoscopically or thoracoscopically. Small defects can be closed directly, but larger defects will require mesh coverage. Care should be taken to avoid using fixation tacks close to the central tendon and are best suited to peripheral defect repairs.

Intercostal Hernia due to Forceful Coughing With Protrusion of the Lung

Intercostal herniation is an abnormal protrusion of lung tissue through the boundaries of the thoracic cavity. It is commonly seen after chest trauma or thoracic surgery but rarely occurs spontaneously. We report a male patient who presented with an intercostal herniation after vigorous coughing for over 2 weeks. Treatment of post-coughing intercostal hernias is either conservative management or surgical intervention, which is dictated by the signs, symptoms, site, and presence of strangulation.

Hernia intercostal abdominal con preservación diafragmática de origen desconocido [Abdominal intercostal hernia with diaphragmatic preservation of unknown origin]

<p>Las hernias intercostales son muy poco frecuentes y las que han sido reportadas en la literatura muestran un origen traumático. Por ello, presentamos un caso insólito al ocurrir en un paciente sin antecedente traumático conocido además de otros datos peculiares como la presencia de hernia intercostal con preservación diafragmática, asociación muy poco frecuente. El diagnóstico radiológico es fundamental y permite orientar la estrategia terapeútica adecuada. En la mayoría de los casos el tratamiento quirúrgico se basa en la reparación herniaria asociada a la utilización de material protésico que , como en el caso presentado, permiten una buena evolución clínica de los pacientes.</p><p> </p><p>ABSTRACT</p><p>Intercostal hernias are very rare and those reported in the literature show a traumatic origin. Therefore, we present an unusual case when occurring in a patient without a traumatic history known in addition to other peculiar data such as the presence of intercostal hernia with diaphragmatic preservation, very rare association. Radiological diagnosis is essential and allows to guide the appropriate therapeutic strategy. In most cases surgical treatment is based on herniary repair associated with the use of prosthetic material which, as in the case presented, allow a good clinical evolution of patients.</p>