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Inicio Gastroenterología y Hepatología (English Edition) Bowel obstruction secondary to transdiaphragmatic intercostal hernia
Journal Information
Vol. 45. Issue 7.
Pages 557-558 (August - September 2022)
Vol. 45. Issue 7.
Pages 557-558 (August - September 2022)
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Bowel obstruction secondary to transdiaphragmatic intercostal hernia
Obstrucción intestinal secundaria a hernia intercostal transdiafragmática
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Lara Blanco Terés
Corresponding author
blancotereslara@gmail.com

Corresponding author.
, Íñigo García Sanz, Cristina Marín Campos, Álvaro Gancedo Quintana, Elena Martín-Pérez
Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
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A 67-year-old man with a history of asthma visited the accident and emergency department with vomiting and dyspnoea. A chest X-ray showed complete occupation of the left half of the chest by bowel loops. Computed tomography showed a defect measuring 9 × 6 cm in the middle part of the left diaphragm (Fig. 1A) and a bulky hernial sac containing virtually all the patient's bowel loops, which were found to be dilated. Part of the bowel contents were herniated between the ninth and tenth left ribs (Fig. 1B), leading to a change in calibre (Fig. 2). The patient underwent emergency surgery by laparotomy with reduction of the contents to the abdominal cavity, resection of a metre of ischaemic jejunum and anastomosis, with left chest tube placement and repair of the diaphragmatic defect with Gore-Tex mesh. The patient followed a favourable postoperative course.1–3

Figure 1.

Computed tomography (CT) of the chest and abdomen with administration of intravenous contrast. (A) Sagittal slice: diaphragmatic hernia with a hernial orifice measuring 9 × 6 cm (*). (B) Coronal slice: bulky hernial sac in the left chest containing dilated bowel loops up to the apex. Part of the contents were herniated between the ninth and tenth left ribs (arrow).

(0.22MB).
Figure 2.

Transverse slice of the chest. Change in bowel calibre between the ninth and tenth left ribs (arrow).

(0.08MB).
References
[1]
V. Kalles, M. Dasiou, G Doga, I Papapanagiotou, EA Konstantinou, A Mekras, et al.
Posstraumatic transdiaphragmatic intercostal hernia: report of a case and review of the literature.
Int Surg, 100 (2015), pp. 444-449
[2]
I. Loumiotis, D.P. Ceppa.
Giant transdiaphragmatic intercostal hernia.
Ann Thorac Surg, 104 (2017), pp. e93
[3]
A. Sapp, T. Nowack, DB Christie.
Transdiaphragmatic intercostal hernia after trauma: a case report, literature review, and discussion of a challenging clinical scenario.
Copyright © 2021. Elsevier España, S.L.U.. All rights reserved
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