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Published on: January 23, 2026
[Transdiaphragmatic intercostal hernia induced by coughing: A case report]
Luis Gisli Rabelo1, Bjarni Geir Vidarsson1
1Faculty of Medicine, University of Iceland, Reykjavik, Iceland, General Surgery department at Landspitali University Hospital, Reykjavik, Iceland.
Laeknabladid
|June 26, 2026
Summary
Transdiaphragmatic intercostal hernias (TDIH) are rare defects. A case study highlights a spontaneous TDIH in an elderly male with COPD, successfully repaired with mesh.
Area of Science:
- Thoracic surgery
- Gastroenterology
- Medical case reports
Background:
- Transdiaphragmatic intercostal hernias (TDIH) are uncommon conditions involving abdominal organs protruding through chest wall defects.
- While often linked to trauma, spontaneous TDIH can occur, sometimes triggered by forceful actions like severe coughing.
- Pre-existing conditions such as chronic obstructive pulmonary disease (COPD) and obesity may increase susceptibility.
Purpose of the Study:
- To report a rare case of spontaneous Transdiaphragmatic intercostal hernia (TDIH).
- To illustrate the clinical presentation and successful management of TDIH in a patient with significant comorbidities.
- To highlight the role of imaging and surgical intervention in managing complex diaphragmatic and intercostal defects.
Main Methods:
- A case study approach was used, focusing on a single patient.
- Diagnostic imaging, including CT scans, was employed to identify the hernia and its contents.
- Surgical intervention involved an open repair procedure utilizing Gore-Tex mesh for reinforcement.
Main Results:
- A right-sided Transdiaphragmatic intercostal hernia was diagnosed, with abdominal viscera present in the thoracic cavity.
- The patient, an elderly male with COPD and obesity, experienced TDIH following severe coughing due to a respiratory infection.
- Successful open surgical repair was achieved using Gore-Tex mesh to address both diaphragmatic and intercostal defects.
Conclusions:
- Spontaneous Transdiaphragmatic intercostal hernia can occur in patients with risk factors like COPD and obesity, precipitated by severe coughing.
- Prompt diagnosis via imaging and surgical repair with mesh reinforcement are effective treatment strategies.
- This case underscores the importance of considering TDIH in the differential diagnosis of respiratory distress and chest/abdominal pain.
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