Gastric volvulus and tension gastrothorax secondary to spontaneous transdiaphragmatic intercostal hernia

Abstract

Spontaneous transdiaphragmatic intercostal hernia is an extremely rare clinical entity featuring dual defects in the diaphragm and chest wall. We report on the case of a 59-year-old man who developed a large left-sided hernia secondary to the minor trauma of a coughing fit. The hernia subsequently enlarged over the course of 3 years until it contained the stomach, leading to a gastric volvulus and tension gastrothorax with secondary pneumothorax. A subtotal gastrectomy was performed with Roux-en-Y reconstruction, and he made a full recovery.

Costal margin injuries and trans-diaphragmatic intercostal hernia: Presentation, management and outcomes according to the Sheffield classification

“…Clinical presentation and features of CMR + IH and TDIH are similar, and the repair of the ruptured diaphragm component of TDIH with sutures is routine. We proposed that TDIH should be repaired surgically, as there is the risk of volvulus of abdominal organs herniating through the DR 5,19 . The indication for surgical repair of CMR + IH should be on symptomatic grounds.…”

“…Clinical presentation and features of CMR + IH and TDIH are similar, and the repair of the ruptured diaphragm component of TDIH with sutures is routine. We proposed that TDIH should be repaired surgically, as there is the risk of volvulus of abdominal organs herniating through the DR. 5,19 The indication for surgical repair of CMR + IH should be on symptomatic grounds. Of course, in the absence of accurate registry data, we are unaware of cases within our population who are not symptomatic and who have not been referred to us for assessment and management, so we do not know if there are asymptomatic cases in the population.…”

“…1,2 Literature concerning the family of costal margin rupture (CMR) injuries is mostly limited to case reports of one or a handful of cases. [1][2][3][4][5][6][7][8][9][10][11] Prior to the publication of the proposed Sheffield Classification of injuries associated with the costal margin, 1 taxonomy of CMR was variable. In proposing the Sheffield Classification, systematic analysis of computed tomography (CT) scans was applied to 19 cases, to ensure accuracy of management and to guide management.…”

“…Costal margin injuries are under-diagnosed, inconsistently managed, and carry significant symptom burden 1,2 . Literature concerning the family of costal margin rupture (CMR) injuries is mostly limited to case reports of one or a handful of cases 1–11 …”