An enigma of spontaneous combined transdiaphragmatic, intercostal and abdominal wall hernia

• Published in: Hernia : the journal of hernias and abdominal wall surgery Vol. 17; no. 3; pp. 415 - 418
• Main Authors: Abu-Gazala, M., Ratnayake, A., Abu-Gazala, S., Bala, M.
• Format: Journal Article
• Language: English
• Published: Paris Springer-Verlag 01.06.2013; Springer Nature B.V
• Subjects: Abdominal Surgery; Case Report; Cough - complications; Hernia, Abdominal - diagnostic imaging; Hernia, Abdominal - etiology; Hernia, Abdominal - surgery; Hernia, Diaphragmatic - diagnostic imaging; Hernia, Diaphragmatic - etiology; Hernia, Diaphragmatic - surgery; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Rib Fractures - diagnostic imaging; Rib Fractures - etiology; Tomography, X-Ray Computed; Transthoracic approach; Intercostal hernia; Spontaneous diaphragmatic hernia
• ISSN: 1265-4906; 1248-9204
• DOI: 10.1007/s10029-012-0902-9

Introduction Cough can be associated with many complications. Materials and methods We present a 59-year-old male patient with a very rare combination of a cough-related stress fracture of the ninth rib and herniation through the diaphragm and abdominal wall to the subcutaneous tissue of the chest wall. We suggest thoracotomy through the affected intercostal defect as a surgical approach. The diaphragm, chest wall and abdominal tears were repaired separately, and the abdominal wall was reinforced with mesh. Technical aspects were discussed. Conclusions Though each individual injury is well documented in the literature, this is a rare combination of defects, requiring early recognition to provide repair before incarceration and further enlargement of the defects occur.