Post-traumatic transdiaphragmatic intercostal hernia: report of two cases

Abstract

Transdiaphragmatic intercostal hernias (TIH) are rare. Less than 40 cases of TIH have so far been reported, with only 8 cases involving herniation of the liver. This report presents the case of 2 patients with a right-sided abdominal lump following a fall. Thoracoabdominal CT-scan showed a TIH between the 9th and 10th ribs with liver and right colonic herniation in both patients. Both patients were successfully treated with mesh repair. The presentation, physiopathology and management of this rare occurrence are discussed.

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

“…1,3,4 The second mechanism is the delayed presentation, as described in the present case, where the physical activity and respiratory movements lead to enlargement of an initially small defect in the thoracic wall and/or the diaphragm that might initially be occult. 5,6 From an anatomical point of view, the chest wall is weaker from the costochondral junction to the sternum, due to the lack of external intercostal muscle support, and from the costal angle posteriorly to the vertebrae due to the lack of internal intercostal muscle support. 7 Lung or abdominal contents may be herniated upon development of defects in these areas, 8 although usually the weakened space is a result of a traumatic incident.…”

“…2 If no diaphragmatic abnormality is involved, the term ''abdominal intercostal hernia'' is more appropriate. 2 Intercostal hernias have been described to occur with two distinct mechanisms: First, they can occur acutely secondary to a penetrating trauma or a direct blunt trauma, 5 or even after repeated violent coughing episodes. 1,3,4 The second mechanism is the delayed presentation, as described in the present case, where the physical activity and respiratory movements lead to enlargement of an initially small defect in the thoracic wall and/or the diaphragm that might initially be occult.…”

“…Abdominal, thoracoabdominal, and thoracic approaches have all been used in order to access the hernia sac and repair the defect. 5,20 The abdominal approach is often used in trauma patients, as the mechanism of injury might be associated with concurrent intra-abdominal injuries. Conservative management might also be considered in asymptomatic patients or elderly patients with significant comorbidities.…”

“…12 There are only a few reports, including the present, of liver segments being contained in an intercostal hernia, with or without other coexisting abdominal viscera (Table 1). 4,5,10,[12][13][14][15][16][17] The diagnosis of intercostal hernia has been historically challenging, with the interval between the initial traumatic incident and the repair of the hernia varying from immediately after the trauma to more than three decades later. 9 Clinically, a patient with transdiaphragmatic intercostal hernia would typically present with a reducible, palpable soft tissue lump in the lower chest wall with a positive cough impulse.…”

Laparoscopic Repair of an Abdominal Intercostal Hernia Following Blunt Trauma: A Case Report

“…Abdominal hernias that protrude through the intercostal muscles, however, are a rare phenomenon. Less than 40 cases of transdiaphragmatic intercostal hernias have been reported in the literature [1,2]. Even fewer still are cases of intercostal hernias under an intact diaphragm [3].…”