Devan Lenhart DO* and Daniel Vera MD
Background: Transdiaphragmatic Intercostal Hernia (TDIH) is an uncommon hernia occurring through a defect in the diaphragm and intercostal space. The etiology of both diaphragmatic and intercostal hernias can be traumatic, acquired, or congenital. Diaphragmatic hernias may be repaired from an abdominal or thoracic approach while intercostal hernias are generally repaired through a thoracotomy.
Case presentation: A 63-year-old male with a background of Chronic Obstructive Pulmonary Disease (COPD), Myocardial Infarction (MI), heart failure, and Pulmonary Embolism (PE) presented with right-sided abdominal pain and dyspnea for one week. The patient was found to have a transdiaphragmatic intercostal hernia. The patient underwent laparoscopic transdiaphragmatic intercostal hernia reduction and repair of the diaphragmatic defect. A right anterolateral thoracotomy was performed to repair the intercostal hernia. The patient has been seen in follow up with no evidence of recurrence.
Conclusions: This patient presented with a unique pathology requiring a thoracoabdominal approach to repair his transdiaphragmatic intercostal hernia. Clinicians should maintain a high level of suspicion when evaluating patients with abdominal pain, dyspnea, and chest wall bulge to avoid delay in diagnosis and treatment of a transdiaphragmatic intercostal hernia.
