Abstract
The patient was an 85-year-old woman who had been conservatively treated at another hospital for six months because of fractures of multiple bones including the right rib caused by involvement in a motor vehicle accident in December 2009. In May 2011 she was referred to our hospital because of constipation and abdominal pain. Abdominal CT scan revealed that small intestines had prolapsed into the thoracic cavity through a defect of the right diaphragm and further prolapsed from the ninth intercostal space to the outer layer of thoracic cage. Traumatic transdiaphragmatic intercostals hernia (TIH) was diagnosed. Operation was performed via the transthoracic approach from an area right above the hernia sac. The small intestines and the greater omentum adhered to the thoracic wall were reduced to the abdominal cavity, and the diaphragmatic defect was closed by sutures using non-absorbable thread. As for the intercostal hernia, we performed closure of the pleura followed by plication suture of the superior and inferior ribs. The patient remains in good condition without clinical and radiological evidence of disease recurrence.
TIH is a rare condition and so far only 18 cases have been reported in the world. This approach that we selected for the patient is an excellent operative procedure because the diaphragmatic defect could be situated under the surgical wound and the intercostal defect as well as the diaphragmatic defect could be easily repaired.
