Case Report: Combined Intercostal-Transdiaphragmatic-Abdominal Wall Hernia
P Martínez-López1,2, M Verdaguer-Tremolosa1,2, V Rodrigues-Gonçalves1,2
1Department of Surgery, UD of Medicine of Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Journal of Abdominal Wall Surgery : JAWS
|July 21, 2025
Summary
A rare intercostal, transdiaphragmatic, and abdominal wall hernia occurred in an elderly male with chronic obstructive pulmonary disease (COPD) after severe coughing. Surgical repair was successful, emphasizing early multidisciplinary treatment for complex hernias.
Area of Science:
- General Surgery
- Thoracic Surgery
- Gastrointestinal Surgery
Background:
- Spontaneous intercostal, transdiaphragmatic, and abdominal wall hernias are exceptionally rare, particularly in patients with chronic obstructive pulmonary disease (COPD).
- Severe coughing episodes can precipitate such complex herniations, posing diagnostic and therapeutic challenges.
Observation:
- A 72-year-old male with a history of COPD presented with thoracic and abdominal swelling following severe coughing.
- CT imaging revealed an intercostal hernia with transdiaphragmatic extension and abdominal wall involvement, containing significant portions of the stomach and intestines.
Findings:
- The patient underwent successful open thoraco-abdominal surgery with preperitoneal hernioplasty and mesh placement to repair the diaphragmatic and costal defects.
- Histopathological examination confirmed the hernia contents and integrity of the repaired tissues.
Implications:
- This case underscores the need to consider complex hernias in COPD patients experiencing severe coughing and abdominal/thoracic swelling.
- Early diagnosis and a multidisciplinary surgical approach are crucial for managing these rare and complex conditions.
- This presentation highlights the potential for spontaneous herniation through weakened abdominal and diaphragmatic structures exacerbated by increased intra-thoracic pressure.
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