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[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
PubMed

Insights

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.

Keywords:
Transdiaphragmatic intercostal herniaabdominal surgerycase reportgeneral thoracicnon-traumatic

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