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.

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>

Laparoscopic IPOM repair of an acquired abdominal intercostal hernia

Acquired abdominal intercostal hernia (AAIH) is an infrequent occurrence whereby intra-abdominal contents herniate into intercostal space directly from the peritoneal cavity through an acquired defect in the abdominal wall musculature and fascia. These hernias are difficult to diagnose and should always be suspected when a chest wall swelling occur after major or minor trauma. Surgical repair is warranted in symptomatic patients. The majority of AAIHs are repaired through an open approach using tension-free mesh, with significant recurrence risk. Recently, laparoscopic and robot-assisted repairs have been proposed. We discuss a 49-year-old man presented through outpatient setting with a 5-year history of ongoing left subcostal discomfort and a reducible lump. His history included a workplace accident 5 years ago. Contrast-enhanced abdominal CT confirmed AAIH with omentum herniation into the sac. A successful laparoscopic repair with intraperitoneal onlay mesh technique using composite mesh was performed.