A Rare Case of Thoracoschisis

Abstract

A term male baby, after delivery, was found to have a 3-centimeter beefy-red mass protruding from the left chest wall, adjacent to the left nipple. Radiological imaging suggested it's origin from the left lateral liver segment. A diagnostic laparoscopy confirmed the isolated connection to the liver, elevated left hemidiaphragm, and protrusion between the ribs. The mass was excised using electrocautery, and pathologic examination showed normal liver tissue.

Isolated Thoracoschisis with Rib Agenesis and Liver Herniation: A Case Report

“…In some cases, as described by Karaman et al and Grijs et al, the herniated tissue, consisting of either liver, stomach, omen-tum, or transverse colon, was able to be separated from adhesions to the chest wall, so a simple reduction and primary repair was successful [7,10]. Our case falls more into the group of cases described by Travers et al and Harris et al, in which the external herniated tissue, mainly liver, needed to be resected prior to reduction [9,11]. These 2 reports are similar to our case, as the only tissue herniated through the thoracic wall defect was part of the liver.…”

“…An important distinction between different cases of isolated thoracoschisis is the presence of rib agenesis. In reports by Harris et al, Saleim et al, and Karaman et al, there was an enlarged intercostal space between the ribs, but no rib agenesis was present [7,8,11]. In comparison, Grijs et al and Travers et al noted segmental agenesis of the involved ribs [9,10].…”

“…Thoracoschisis is classified as a part of the “Limb-Body Wall Complex” (LBWC) deformities, being more commonly associated with other birth defects such as limb agenesis, anterior thoracic wall deformities, phocomelia, and diaphragmatic hernias [1–6]. However, of the 14 total reported cases of thoracoschisis, 5 cases had no other related abnormalities [7–11].…”

“…Treatment of thoracoschisis is varied but involves primary management to assure hemodynamic and respiratory stability, followed by imaging for diagnosis, and finally either surgical reduction of abdominal contents through subcostal incision or gastroschisis-like silo bags. This is followed by closure of the thoracic wall, re-approximation of separated ribs, or plans to do staged reconstruction of the thoracic wall post-operatively [10,11]. In this case report we present a rare instance of a term male infant with an isolated left-sided thoracoschisis and rib agenesis.…”