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Ann Thorac Surg 2004;77:699-701
© 2004 The Society of Thoracic Surgeons

Case report

Recurrent intercostal herniation of the liver

Julian E. Losanoff, MDa, Bruce W. Richman, MAa, James W. Jones, MD, PhDa*

a Department of Surgery, University of Missouri-Columbia, Columbia, Missouri, USA

Accepted for publication April 29, 2003.

* Address reprint requests to Dr Jones, Department of Surgery (M580 HSC), University of Missouri-Columbia, One Hospital Drive, Columbia, MO 65212, USA
e-mail: jonesjw{at}health.missouri.edu

Abdominal intercostal hernia occurs rarely, with only 26 previous cases reported in the professional literature. A 51-year-old man presented with a painful right chest protrusion. One year earlier he had experienced a severe coughing spell and spontaneous rib fracture and chest protrusion. He was treated with endogenous tissue reinforcement and had no clinical improvement. Magnetic resonance imaging revealed the liver protruding through the chest wall. The hernia was reduced and the chest wall was repaired with prosthetic mesh and cables. Attention to the chest wall anatomy and reliable tissue closure including pericostal or transcostal nonabsorbable sutures and a prosthetic bridge over the defect are the best way to eliminate the patient's risk for recurrence.




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