Post-Traumatic Abdominal Intercostal Hernia
AAPA ePoster library. Bowker B. 05/17/17; 180554; 232
Brennan Bowker
Brennan Bowker
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Abstract
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Introduction: Abdominal intercostal hernias are a rare form of hernia, most often observed after major trauma. Although there have been few reported cases in the literature, it is essential that clinicians have a high index of suspsion for this process as these patients are at higher risk of incarceration and strangulation. Methods: The patient is a 76-year-old female who, four years prior to her presentation, had been involved in a significant motor vehicle collision that resulted in multiple left sided rib fractures. Although there were no immediate sequelae of this incident, the patient noticed shortly after that she had a 'lump' on her left side that over the course of a year enlarged to the point where it was bothersome. A computerized tomography (CT) scan of the abdomen was obtained and was not only notable for multiple left sided rib fractures which had healed poorly, but also for an intercostal hernia at the 7th intercostal space. Although mostly fat containing, this hernia also contained a small portion of the splenic flexure. Unfortunately, this patient was lost to follow up after the initial imaging until 3 years later when she was referred to a general surgeon for definitive management of her hernia. At this point, the hernia had enlarged and was causing her pain. After careful review of the CT scan, it was decided that a laparoscopic approach would be best suited to repair the hernia. In the operating room, two hernia defects were appreciated. The most caudal defect was only a few centimeters below the diaphragm which prevented the placement of tacks at the superior most portion of the mesh. A 20 x 15 cm piece of Ventralight ST mesh (Bard, Warwick, RI) was placed and the Protac device was used to secure the mesh to the anterior abdominal wall. As the pneumoperitoneum was reduced, the abdominal contents were observed to come over the mesh and not under it. The patient was admitted for observation and discharged home the following morning. Results: Intercostal hernias are an extremely rare type of hernia that have been minimally addressed in the literature. While often used interchangeably, intercostal hernias can be divided into transdiaphragmatic intercostal hernias (TIH) and abdominal intercostal hernias (AIH). Both occur due to a weakness in the thoracoabdominal wall and in 65% of cases, major trauma such as rib fracture, deceleration injury, or penetrating trauma is the inciting factor. There is, however, a small subs...
Introduction: Abdominal intercostal hernias are a rare form of hernia, most often observed after major trauma. Although there have been few reported cases in the literature, it is essential that clinicians have a high index of suspsion for this process as these patients are at higher risk of incarceration and strangulation. Methods: The patient is a 76-year-old female who, four years prior to her presentation, had been involved in a significant motor vehicle collision that resulted in multiple left sided rib fractures. Although there were no immediate sequelae of this incident, the patient noticed shortly after that she had a 'lump' on her left side that over the course of a year enlarged to the point where it was bothersome. A computerized tomography (CT) scan of the abdomen was obtained and was not only notable for multiple left sided rib fractures which had healed poorly, but also for an intercostal hernia at the 7th intercostal space. Although mostly fat containing, this hernia also contained a small portion of the splenic flexure. Unfortunately, this patient was lost to follow up after the initial imaging until 3 years later when she was referred to a general surgeon for definitive management of her hernia. At this point, the hernia had enlarged and was causing her pain. After careful review of the CT scan, it was decided that a laparoscopic approach would be best suited to repair the hernia. In the operating room, two hernia defects were appreciated. The most caudal defect was only a few centimeters below the diaphragm which prevented the placement of tacks at the superior most portion of the mesh. A 20 x 15 cm piece of Ventralight ST mesh (Bard, Warwick, RI) was placed and the Protac device was used to secure the mesh to the anterior abdominal wall. As the pneumoperitoneum was reduced, the abdominal contents were observed to come over the mesh and not under it. The patient was admitted for observation and discharged home the following morning. Results: Intercostal hernias are an extremely rare type of hernia that have been minimally addressed in the literature. While often used interchangeably, intercostal hernias can be divided into transdiaphragmatic intercostal hernias (TIH) and abdominal intercostal hernias (AIH). Both occur due to a weakness in the thoracoabdominal wall and in 65% of cases, major trauma such as rib fracture, deceleration injury, or penetrating trauma is the inciting factor. There is, however, a small subs...
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