Posttraumatic Transdiaphragmatic Intercostal Hernia: Report of a Case and Review of the Literature

Intercostal hernias are rare, and usually occur following injuries of the thoracic wall. The scope of this report is to present a case of a 53-year-old obese patient that developed a transdiaphragmatic intercostal hernia. The patient presented with a palpable, sizeable, reducible mass in the right lateral thoracic wall, with evident bowel sounds in the area, 6 months after a motor-vehicle accident. On computed tomography (CT), the hernia sac contained part of the liver and part of the ascending colon. A surgical repair of the defect was performed, using a prosthetic patch. The patient''s postoperative course was uneventful and she remains recurrence free at 12 months after surgery. Intercostal hernias should be suspected following high-impact injuries of the thoracic wall, and CT scans will facilitate the diagnosis of intercostal hernia. We consider the surgical repair of the defect, with placement of a prosthetic mesh, as the treatment of choice to ensure a favorable outcome.Key words: Hernia, Transdiaphragmatic, Intercostal, Abdominal, MeshThe herniation of abdominal contents through the thoracic wall, as a result of the disruption of diaphragmatic and/or intercostal muscles, is an uncommon clinical entity.^1–3 This condition is usually reported to occur following penetrating or blunt injuries of the thoracic wall.⁴ However, there are several cases that have been described to be a consequence of a coughing–spell rib fracture, usually in patients with other predisposing factors such as chronic obstructive pulmonary disease, asthma, advanced age, or osteoporosis.^1,3,4The present report describes a case of a middle-aged obese patient that developed a transdiaphragmatic intercostal hernia involving the liver and the ascending colon 6 months after a traumatic incident. The underlying mechanism, the anatomical and diagnostic considerations, as well as the treatment options are also discussed.