Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
J Cardiothorac Surg. 2023 Jul 4;18(1):212. doi: 10.1186/s13019-023-02320-3.
Transdiaphragmatic intercostal hernia is a rare disease. It is usually caused by trauma and is rarely caused by coughing. Although a few cases of intercostal hernia induced by coughing have been reported, our case of a non traumatic acquired acute transdiaphragmatic intercostal and abdominal hernia induced by coughing is very rare. A 77-year-old woman presented with sudden-onset left lower chest pain after an episode of violent coughing. She had risk factors for intercostal hernia, including obesity, chronic obstructive pulmonary disease, oral steroid use, and diabetes mellitus. Computed tomography showed herniation of the lung and intra-abdominal organs into the thoracic and abdominal wall through a ruptured diaphragm, as well as the intercostal and abdominal muscles. Surgery was completed with interrupted sutures to close the defects after the reduction of the herniated organs. Our experience suggests that careful examinations, including the assessment of risk factors and computed tomography imaging, were essential for establishing an accurate diagnosis, and that the repair of a ruptured diaphragm with simple interrupted sutures without any prosthetic materials seems to be feasible in selected patients with a transdiaphragmatic intercostal hernia.
膈疝是一种罕见的疾病。它通常由创伤引起，很少由咳嗽引起。虽然有少数由咳嗽引起的膈疝的病例报告，但我们报告的由咳嗽引起的非创伤性获得性急性膈疝和腹疝非常罕见。一名 77 岁女性在剧烈咳嗽后突发左侧下胸部疼痛。她存在膈疝的危险因素，包括肥胖、慢性阻塞性肺疾病、口服类固醇药物使用和糖尿病。计算机断层扫描显示肺和腹腔器官通过破裂的横膈膜疝入胸腹壁，以及肋间肌和腹肌。在疝出器官复位后，通过间断缝合关闭缺陷以完成手术。我们的经验表明，仔细检查，包括评估危险因素和计算机断层扫描成像，对于建立准确的诊断至关重要，并且在选择的膈疝患者中，使用简单间断缝合而不使用任何假体材料修复破裂的横膈似乎是可行的。
