Laparoscopic IPOM repair of an acquired abdominal intercostal hernia

Abstract

Acquired abdominal intercostal hernia (AAIH) is an infrequent occurrence whereby intra-abdominal contents herniate into intercostal space directly from the peritoneal cavity through an acquired defect in the abdominal wall musculature and fascia. These hernias are difficult to diagnose and should always be suspected when a chest wall swelling occur after major or minor trauma. Surgical repair is warranted in symptomatic patients. The majority of AAIHs are repaired through an open approach using tension-free mesh, with significant recurrence risk. Recently, laparoscopic and robot-assisted repairs have been proposed. We discuss a 49-year-old man presented through outpatient setting with a 5-year history of ongoing left subcostal discomfort and a reducible lump. His history included a workplace accident 5 years ago. Contrast-enhanced abdominal CT confirmed AAIH with omentum herniation into the sac. A successful laparoscopic repair with intraperitoneal onlay mesh technique using composite mesh was performed.

Abdominal intercostal hernia and costal arch repair

“…This case of abdominal intercostal hernia highlights a surgical condition with a delayed presentation after significant trauma. Similar cases have been presented 5 years after the traumatic event,5 and diaphragmatic rupture without intercostal involvement has been reported to present after 50 years 6. In contrast to lung herniation which can be managed conservatively if the patient is asymptomatic,7 abdominal intercostal hernias require surgical repair.…”

“…In the literature, there are multiple cases involving the eighth intercostal space,5 8 9 and it is theorised that there is a part of the diaphragm which is more susceptible to being detached from the lateral thoracic wall just below this point. While these cases are able to be repaired laparoscopically, this case involved a costal arch fracture necessitating open repair.…”