LAUSR

Intercostal posttraumatic hernias are very rare but clinically significant conditions that occur as a result of blunt or penetrating chest trauma. A 66-year-old female with a history of high energetic trauma and consequent 8th and 9th right rib fractures presented several months later with a progressive onset of right side swelling. The CT scan revealed an intercostal hernia between the 8th and 9th right ribs, containing small bowel loops and right colon. A month prior to surgery 300 IU of Botox® was injected bilaterally in between the lateral muscles of the abdominal wall. A combined thoracic and abdominal open repair approach was performed. An anterior disruption of the diaphragm was appreciated, which led to the presence of abdominal contents in the pleural cavity. The repair combined the placement of a P4HB mesh with a PP mesh in the retromuscular space. Then, the diaphragm was sutured using reinforced teflon pledgets, polypropylene single stitches and a second P4HB mesh was placed on top of it. Finally, the 8th and 9th ribs were reapproximated using non-absorbable sutures. The postoperative period was uneventful, and no recurrence occurred during the first 6-months of follow-up. Managing intercostal hernias resulting from traumatic accidents, can be challenging, especially when anatomical distortions are involved. This case highlights the importance of tailored surgical approaches for addressing intercostal hernias with a meticulous dissection to allow proper identification of the structures involved in the hernia repair.