Incisional intercostal hernia with prolaps of the liver

Case

A 61-year-old obese woman (body-mass-index 44) presented to our clinic with a 4 year history of recurrent discomfort and pain at the lateral edge of a lumbar incision. On physical examination there were no specific findings beside of a diffuse tenderness at the lateral edge of the lumbar incision. The patient had a history of right-sided nephrotomy five years ago due to an angiomyolipoma. An ultrasound and a computed tomography image revealed the liver protruding through a 5 x 7 cm hernial orifice between the eleventh and twelfth rib (Figure 1). Hernia repair using a low weight and large pored polypropylene compound mesh (Ultrapro) in combination with approximation of the ribs with absorbable single sutures (polyglactin, Vicryl) was performed. The postoperative course was uneventful, at 6 months follow-up the patient had no complaints and no evidence for hernia recurrence was found.

Figure 1.

Computed tomography of the abdomen and pelvis.