INTERCOSTAL HERNIATIN OF ABDOMINAL CONTENTS FOLLOWIGN A PENETRATING CHEST INJURY

Traumatic abdominal intercostal hernia without diaphragmatic injury

A hernia through an intercostal space involving the bowel is rare but can result in strangulation of the bowel if not diagnosed promptly. We report a case of bowel herniation through the left 9th intercostal space after blunt trauma in a motor vehicle collision. A mass was present overlying the left lower anterolateral chest wall thought to be a haematoma, but it was eventually diagnosed as an intercostal hernia after CT imaging. The treatment for this injury included diagnostic laparoscopy to rule out other abdominal injuries and local repair of the defect. This report discusses the current literature regarding diagnosis and treatment of this rare phenomenon.

Strangulated intercostal liver herniation subsequent to blunt trauma. First report with review of the world literature

Traumatic transdiaphragmatic intercostal hernia, defined as an acquired herniation of abdominal contents through disrupted intercostal muscles, is a rarely reported entity. We present the first reported case of a traumatic transdiaphragmatic intercostal hernia complicated by strangulation of the herniated visceral contents.

Following blunt trauma, a 61-year old man developed a traumatic transdiaphragmatic intercostal hernia complicated by strangulation of liver segment VI. Due to pre-existing respiratory problems and the presence of multiple other injuries (grade III kidney laceration and lung contusion) the hernia was managed non-operatively for the first 2 weeks.

The strangulated liver segment eventually underwent ischemic necrosis. Six weeks later the resulting subcutaneous abscess required surgical drainage. Nine months post injury the large symptomatic intercostal hernia was treated with laparoscopic mesh repair. Twelve months after the initial trauma, a small recurrence of the hernia required laparoscopic re-fixation of the mesh.

This paper outlines important steps in managing a rare post traumatic entity. Early liver reduction and hernia repair would have been ideal. The adopted conservative approach caused liver necrosis and required staged procedures to achieve a good outcome.

Disruption of the Costal Margin with Transdiaphragmatic Abdominal Herniation Induced by Coughing

We present a case of disruption of the cartilage of the costal margin resulting in herniation of abdominal contents across the diaphragm into the chest and across a gap between the ribs into the subcutaneous tissues. The literature on this condition and its management is reviewed.

Massive ipsilateral pleural effusion caused by transdiaphragmatic intercostal hernia

Transdiaphragmatic intercostal hernia (TDIH) is a rare consequence from blunt chest-abdominal injury. The diagnosis of TDIH is often delayed. We report a patient who had a history of left-sided upper abdominal blunt injury 2 months before admission presented with a newly developed, massive pleural effusion and clinical manifestations of intestinal obstruction. A multidetector-row computed tomography confirmed the diagnosis of traumatic diaphragm rupture and TDIH. He underwent thoracotomy with reduction of herniated viscera and repair of the diaphragm and chest wall. He was discharged uneventfully and remained well on follow-up at 2 months.

Soft right chest wall swelling simulating lipoma following motor vehicle accident: transdiaphragmatic intercostal hernia. A case report and review of literature

INTRODUCTION

Intercostal herniation of abdominal contents through a diaphragmatic defect is rare. We report a case of transdiaphragmatic intercostal hernia secondary to blunt trauma, initially misdiagnosed as lipoma, later confirmed by CT scan.

METHODS

We present a case of a 77-year-old who was involved in a motor vehicle accident and sustained a hand fracture. Later that year his wife noticed an egg-shaped soft swelling on his right chest wall. He was seen in the minor operative clinic, and a lipoma excision was attempted when it was found to be an intercostal hernia. Colon was seen in the hernial pouch.

RESULTS

Anatomically, the chest wall is weak from the costochondral junction to the sternum because of lack of external intercostal muscle support, and from the costal angle posteriorly to the vertebrae because of lack of internal intercostal musculature. The integrity of the thoracic cage is disrupted by tears of the intercostal musculature between fractured ribs. This defect leads to separation of the ribs and development of a potential weakened space for hernia. This chest wall muscular weakness can occur anywhere and can be more pronounced if it occurs at anatomically weakened areas. In the presence of associated diaphragmatic rupture, there is herniation of abdominal viscera. The treatment includes immediate surgical repair either by abdominal or thoracoabdominal approach.

CONCLUSIONS

A thorough physical examination may suggest the diagnosis, but confirmation by chest radiograph, CT scan, and sometimes by gastrointestinal contrast studies is often helpful for preoperative planning. A high index of suspicion for diaphragmatic injury or intercostal herniation during the initial evaluation, coupled with chest and abdominal diagnostic testing once the patient is stable, can avert undue delay in diagnosis and catastrophe from incarceration of a hernia.

Acquired spontaneous intercostal abdominal hernia: case report and a comprehensive review of the world literature

Intercostal hernias develop most often as a result of a blunt or penetrating thoracoabdominal trauma. We know of no prior report of a spontaneously occuring intercostal hernia. This study presents a review of the published literature that deals with this uncommon phenomenon, along with a discussion of our patient's clinical presentation and imaging findings.

Transdiaphragmatic intercostal hernia

A 72-year-old man was seen with cough-induced rib fractures, a diaphragmatic tear, and an intercostal hernia containing abdominal contents. A review of the literature of this rare problem is presented, and techniques of repair are discussed.