A case of spontaneous transdiaphragmatic intercostal hernia of bowel loops and omentum with herniation of lung – A very rare entity

Sit, Arnab; Chatterjee, Suman; Das, Ira; Datta, Arundhati; Jana, Pulak Kumar; Joseph, Jineesh; Chakraborty, Ritam; Lala, Sibkinkar

doi:10.1016/j.ejcdt.2015.12.007

Cited by 2 publications

(2 citation statements)

References 9 publications

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“…Another thought is that the fracture is associated with the opposing forces of the intercostal, diaphragmatic, abdominal, and serratus muscles on the rib [ 5 ]. This explains the reason these fractures are often found laterally and between the 5th and 9th ribs [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

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A Case of Spontaneous Transdiaphragmatic Intercostal Hernia with Contralateral Injury, and Review of the Literature

Chapman

Duff

2017

Case Reports in Surgery

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This case report discusses the diagnosis and management of a 67-year-old male presenting with a spontaneous transdiaphragmatic intercostal hernia with contralateral intercostal hernia. The patient had a history of chronic obstructive pulmonary disease (COPD) exacerbations requiring multiple prolonged courses of steroids. The patient was ultimately diagnosed with computed tomography (CT) and underwent surgical repair via thoracotomy with primary repair of the diaphragmatic defect. The patient's postoperative course was uncomplicated. A review of the literature since the first similar case in 1977 recognizes the propensity of this injury to be found in patients with COPD and chronic steroid usage, as well as its diagnosis and management. The case reviewed is the second documented case of a concurrent abdominal wall herniation and the first one with a contralateral injury. It is important for clinicians to be aware of this pathology when evaluating patients with COPD and chronic steroid usage.

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Section: Discussionmentioning

confidence: 99%

“…Evidence of ischemia or necrosis mandates excision of that portion of bowel. Chest tube drainage of the thorax is also employed [ 5 , 7 , 9 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

A Case of Spontaneous Transdiaphragmatic Intercostal Hernia with Contralateral Injury, and Review of the Literature

Chapman

Duff

2017

Case Reports in Surgery

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Unifying classification for transdiaphragmatic intercostal hernia and other costal margin injuries

Gooseman

Rawashdeh

Mattam

et al. 2019

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Taxonomy of injuries involving the costal margin is poorly described and surgical management varies. These injuries, though commonly caused by trauma, may also occur spontaneously, in association with coughing or sneezing, and can be severe. Our goal was to describe our experience using sequential segmental analysis of computed tomographic (CT) scans to perform accurate assessment of injuries around the costal margin. We propose a unifying classification for transdiaphragmatic intercostal hernia and other injuries involving the costal margin. We identify the essential components and favoured techniques of surgical repair. METHODS Patients presenting with injuries to the diaphragm or to the costal margin or with chest wall herniation were included in the study. We performed sequential segmental analysis of CT scans, assessing individual injury patterns to the costal margin, diaphragm and intercostal muscles, to create 7 distinct logical categories of injuries. Management was tailored to each category, adapted to the individual case when required. Patients with simple traumatic diaphragmatic rupture were considered separately, to allow an estimation of the relative incidence of injuries to the costal margin compared to those of the diaphragm alone. RESULTS We identified 38 patients. Of these, 19 had injuries involving the costal margin and/or intercostal muscles (group 1). Sixteen patients in group 1 underwent surgery, 2 of whom had undergone prior surgery, with 4 requiring a novel double-layer mesh technique. Nineteen patients (group 2) with diaphragmatic rupture alone had a standard repair. CONCLUSIONS Sequential analysis of CT scans of the costal margin, diaphragm and intercostal muscles defines accurately the categories of injury. We propose a ‘Sheffield classification’ in order to guide the clinical team to the most appropriate surgical repair. A variety of surgical techniques may be required, including a single- or double-layer mesh reinforcement and plate and screw fixation.

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A case of spontaneous transdiaphragmatic intercostal hernia of bowel loops and omentum with herniation of lung – A very rare entity

Cited by 2 publications

References 9 publications

A Case of Spontaneous Transdiaphragmatic Intercostal Hernia with Contralateral Injury, and Review of the Literature

A Case of Spontaneous Transdiaphragmatic Intercostal Hernia with Contralateral Injury, and Review of the Literature

Unifying classification for transdiaphragmatic intercostal hernia and other costal margin injuries

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