Intercostal pleuroperitoneal hernia.

The patient described in this report had the initial symptoms and signs of a fractured right ninth rib followed soon by severe signs of trauma to the local chest wall. In the ensuing 5 months sequella suggesting an intercostal hernia gradually developed. Further studies indicated that this hernia consisted of a posterior pleural and anterior peritoneal component. At operation the diaphragm was found to have torn away from its costal attachments. In addition to repairing the intercostal pleural hernia, we recommend that a strip of Marlex mesh be fixed to the inner costal surfaces to form a continuous and durable new attachment for the diaphragmatic margin prior to the repair of the peritoneal component. Determining a probable explanation for the mechanism of the injury was helpful in understanding the reconstruction procedure.