Transdiaphragmatic Intercostal Herniation following Blunt Trauma

Abstract

Intercostal herniation is very rarely and sporadically reported in the literature. Intercostal hernia can occur following blunt trauma and may be associated with rib fractures. We present a case of a patient who presented with rib fractures, diaphragmatic rupture, and intrathoracic herniation of abdominal contents with subsequent herniation of both lung and abdominal contents through an intercostal defect. The patient was successfully treated with primary surgical repair of the diaphragm and intercostal hernia. The presentation, pathophysiology, and management of this rare clinical entity are discussed.

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

“…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.…”

“…Currently, there is no consensus recommendation regarding the use of prosthetic mesh. 20 However, it has been reported that the nonuse of prosthetic reinforcement is associated with recurrence. 21 Concurrent rib fractures are usually not stabilized, but cable banding around the ribs to counteract the dehiscence tension forces has also been suggested as a reliable method of repairing those hernias for which massive loss of chest wall integrity precludes endogenous repair.…”

Post-traumatic pulmonary hernia

“…Post-traumatic pulmonary hernia is a very rare occurrence of chest trauma, which however remains usually covered by the skin 1 2. A young 22-year-old male was recently admitted to our trauma centre after being thrown from a motorcycle against a road guard barrier.…”

Clinicoradiological diagnosis: Cough-induced transdiaphragmatic intercostal herniation

“…Shearing forces on a stretched membrane, avulsion of the diaphragm from its point of attachment and a sudden increase in the transdiaphragmatic pleuroperitoneal pressure gradient. 5 This pressure gradient can be increased by coughing, vomiting, exercise or iatrogenic injury. 4 The commonest site of rupture is the posterolateral surface along the embryonic fusion line as it is the weakest part of the diaphragm.…”

“…The morbidity and mortality rate can increase secondary to associated complication of the undiagnosed diaphragmatic injury, mortality ranges from 5–30%. 5 The complications associated with undiagnosed diaphragmatic rupture may include; bowel herniation, incarceration and strangulation; tension haemothorax secondary to massive bowel herniation; pericardial tamponade from herniation into the pericardial sac. 2 …”