Department of Surgery, Division of Minima Access and Bariatric Surgery, Prisma Health Upstate, 701 Grove Rd, ST 3, Greenville, SC, 29605, USA.
Carolinas Medical Center, Gastrointestinal and Minimally Invasive Surgery, Carolinas Laparoscopic and Advanced Surgery Program, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA.
Hernia. 2021 Dec;25(6):1621-1628. doi: 10.1007/s10029-020-02194-7. Epub 2020 Apr 24.
Primary thoracoabdominal hernias involve the triad of an intercostal hernia, abdominal wall hernia, and diaphragmatic hernia. We report a case series of this rare entity and describe the evolution and outcomes.
We completed a retrospective analysis of thoracoabdominal hernia repairs performed January 2010-April 2019 at Prisma Health-Upstate and Carolinas Medical Center. This includes all patients with spontaneous defects, excluding incisional hernias or those resulting from external trauma.
Of 16 patients with thoracoabdominal hernias, 15 patients developed hernias after forceful coughing and one patient developed a hernia after strenuous physical activity. Seven patients required at least one additional intervention; two for recurrence; two for recurrence of original intercostal repairs done elsewhere; two for wound complications; and one had a missed abdominal wall component.
Primary thoracoabdominal hernias require a high index of suspicion. Durable repair involves complex reconstruction of the thoracoabdominal wall including the diaphragm, intercostal space, rib fracture fixation, and mesh reinforcement of the abdominal wall with permanent fixation constructs.
原发性胸腹疝涉及三联征，即肋间疝、腹壁疝和横膈疝。我们报告了一系列这种罕见疾病的病例，并描述了其演变和结局。
我们对 2010 年 1 月至 2019 年 4 月在普里马健康大学医疗中心和卡罗莱纳医疗中心进行的胸腹疝修复手术进行了回顾性分析。这包括所有自发性缺陷的患者，不包括切口疝或由外部创伤引起的疝。
16 例胸腹疝患者中，15 例在剧烈咳嗽后出现疝，1 例在剧烈体力活动后出现疝。7 例患者至少需要进行一次额外的干预；2 例因复发；2 例因在其他地方进行的原有肋间修复术复发；2 例因伤口并发症；1 例漏诊腹壁缺损。
原发性胸腹疝需要高度怀疑。持久的修复需要复杂的胸腹壁重建，包括横膈膜、肋间空间、肋骨骨折固定以及永久性固定结构的腹壁网片加强。
