Incisional Intercostal Hernia With Prolapse of the Colon After Right Partial Nephrectomy

Abstract

A 75-year-old woman with a history of myocardial infarction, gallstones, and right renal cancer was referred to our department because of right flank pain. She had a surgical scar on the right abdomen between the 10th and 11th ribs; computed tomography demonstrated intercostal herniation of the colon. Recognizing the possibility of adhesions of the hernia and colon, we used a median skin incision and patched a polyester mesh coated with absorbent collagen. The patient had an uneventful postoperative course, with no pain for 6 months postoperatively. Transdiaphragmatic intercostal hernias with abdominal contents commonly develop after trauma or thoracic surgery. Incisional intercostal hernias seldom develop after nephrectomy; the present case is only the fourth report. We conjecture that a costochondral incision can induce subluxation of the costotransverse joint, intercostal nerve injury, and atrophy of the intercostal and abdominal oblique muscles. Surgeons must therefore recognize the potential, albeit rare, for intercostal hernia after nephrectomy.

Rare case of a strangulated intercostal flank hernia following open nephrectomy: A case report and review of literature

“…The average age of the patients involved is 60.8 (range 42–79). Contents of the hernia sac in previous reports include small bowel [7] , large bowel [2] , [8] , [9] , [10] , and liver [11] , while our patient had herniation of the right colon. The herniation was most commonly right sided and was left sided in two cases [8] , [9] .…”

“…They are most commonly caused by trauma but can also be caused by previous surgery, after which the hernia would be considered incisional. Flank hernias occur in 0.2% of blunt trauma patients [1] but are also seen after abdominal and thoracic operations [2] . As a part of this group, lateral intercostal herniation following a surgical procedure has been reported in only six cases in world literature.…”

Incarcerated incisional hernia of the sigmoid colon after appendectomy: A case report

“…The small bowel and omentum are commonly herniated organs, but unusual organs such as the bladder and colon may herniate through the abdominal wall defect [5], [6], [7], [8]. The ascending and descending colon are fixed into the retroperitoneum, whereas the transverse and sigmoid colon are not, which can allow these bowel segments to herniate through a weak abdominal wall just as small bowel loops do.…”

Transurethral Electric Coagulation Combined With Retroperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Urothelial Carcinoma

“…4,[7][8][9] There are 2 approaches for the LNU procedure, transperitoneal and retroperitoneal route. The retroperitoneal approach is featured by less interference to abdomen organs and quicker recovery of intestinal function, and it is widely appreciated by urologists and patients.…”