Hernia of the Lung

Maurer, Elmer R.; Blades, Brian

doi:10.1016/s0096-5588(20)31426-4

Cited by 83 publications

(12 citation statements)

References 5 publications

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“…An accurate count of cases is difficult to obtain, as TDIH nomenclature has been variable. [1][2][3][4][5] Risk factors for traumatic TDIH are not well established. As these injuries are uncommon, best management techniques have yet to be established.…”

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confidence: 99%

Transdiaphragmatic Chest Wall Herniation

Meader

Ciraulo

Rappold

et al. 2020

The American Surgeon™

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Background The combination of traumatic simultaneous diaphragmatic rupture and chest wall herniation remains rare, with 42 cases of traumatic transdiaphragmatic intercostal hernia (TDIH) reported in the literature since 1946. An accurate count of cases is difficult to obtain, as TDIH nomenclature has been variable. 1 - 5 Risk factors for traumatic TDIH are not well established. As these injuries are uncommon, best management techniques have yet to be established. Reported repair techniques include primary closure, closure with mesh, and implantation of prosthetic or autologous material. We present our single-center series of 7 patients, the largest reported to our knowledge, and discuss the challenges of repairing these difficult injuries. Methods After obtaining institutional review board approval, data were abstracted from the electronic medical record on all adults who underwent evaluation and treatment for traumatic TDIH between July 2014 and January 2019. Results Of the 7 cases of traumatic TDIH, 6 patients developed TDIH secondary to cough; the seventh patient presented with chronic chest wall pain after an episode of heavy lifting. All patients were obese or overweight. Pain and a “popping sensation” were the most common presenting symptoms. All patients underwent operative intervention with primary repair of the diaphragm and suture approximation of the ribs. 3 patients had onlay mesh repair of the chest wall and/or abdominal wall. 1 patient had plating of his rib fracture. 3 patients had a recurrence of the intercostal portion of the hernia No patients have undergone reoperation thus far. Discussion While previously thought to more commonly occur on the left side due to the protective effects of the diaphragm, 2 the majority in this series had right-sided injuries. Herniation through the ninth-10th interspace remains the most common location. 4 Computed tomography imaging should be used for diagnosis and operative planning. It is best to manage these hernias acutely to re-establish normal anatomy. Mesh may be required in delayed reconstructions of if the chest wall cannot be re-approximated. Rib plating should be considered in cases of instability or flail. High rates of complications are not unexpected given the complicated and rare nature of the injury. Given the high rate of intercostal hernia recurrence, it is likely that mesh repair or should be more often used in the treatment of this injury.

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confidence: 99%

Transdiaphragmatic Chest Wall Herniation

Meader

Ciraulo

Rappold

et al. 2020

The American Surgeon™

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“…In the majority of reported patients, the lung herniates through the intercostal space as a result of trauma or after thoracic surgery [ 6 ]. Since symptomatic lung hernia rarely shows spontaneous healing, surgery is considered the standard treatment [ 7 ]. The main indications for operation are increasing size, pain, and any signs of impending incarceration [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Manual repositioning of lung hernia after minimally invasive cardiac surgery

Koichi

Ise

Ohira

et al. 2019

Journal of Surgical Case Reports

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“…Rib and periosteal flaps can be used in addition to large local flaps. In this situation, an adjacent rib is cut obliquely and its free end wired to the remnants of the remaining rib in the defect, thus traversing the defect and providing more support (4). A local flap then covers the rib and periosteal graft.…”

Section: Discussionmentioning

confidence: 99%

The Split Breast Flap: Revisited – a Medieval Or An Ideal Solution in the Selected Case?

Degreef¹

2011

Canadian Journal of Plastic Surgery

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In assessing a patient requiring palliative reconstruction of the anterior chest wall, a host of techniques engulf the reconstructive surgeon, who has to evaluate the local situation, the tissue lost, the tissue required and the tissue available. The patient's general condition is usually a major influence on this decision. The split breast flap is an often forgotten, simple means of palliative reconstruction.

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Hernia of the Lung

Cited by 83 publications

References 5 publications

Transdiaphragmatic Chest Wall Herniation

Transdiaphragmatic Chest Wall Herniation

Manual repositioning of lung hernia after minimally invasive cardiac surgery

The Split Breast Flap: Revisited – a Medieval Or An Ideal Solution in the Selected Case?

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