Case Reports
Video-Assisted Repair of a Traumatic Intercostal Pulmonary Hernia

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Abstract

A case of traumatic right lung herniation to an area of anterior costal sternal separation and right hemothorax is presented. Application of a thoracoscopic approach to a traumatic lung hernia of the chest wall in this case is discussed.

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Comment

Lung hernias are a rare entity, with approximately 300 cases reported in the literature. They were first described by Roland in 1499 [1] and classified by Morel-Lavalle in 1845 [2]. Approximately 20% of reported cases are described as congenital and 80% as acquired, of which the majority are traumatic in origin 3, 4. Traumatic intercostal hernias are frequently associated with multiple rib fractures or tears in the intercostal muscles. They usually occur in the area adjacent to the sternum,

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    Some have suggested that traumatic supraclavicular hernias may be more amenable to observation because the chest wall defect is typically larger, reducing the risk of incarceration [18]. Thoracoscopically assisted repair of chest wall hernias has also been described as an alternative to thoracotomy [10, 19]. Although we did not attempt any minimally invasive herniorrhaphies, this certainly represents an attractive option in patients without prohibitive pleural adhesions.

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    Repair with nonabsorbable sutures and possibly reinforcement with mesh is advisable, particularly in recurrent defects. [10,12] Repair via video-assisted thoracoscopic surgery is also possible [13,14]. In the case reported here, the child's intercostal hernia resulted at the site of a distant prior thoracostomy, performed at a time when she was receiving immunosuppressant corticosteroids.

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    2007, Journal of Thoracic and Cardiovascular Surgery
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    Because of the large thoracic wall hematoma and extended thoracic wall emphysema in this case, a muscular flap did not seem appropriate, and the mesh was applied rapidly through a posterolateral thoracotomy, reducing the risk of thoracic wall infection. As an alternative approach to open thoracotomy, hernia repair with video-assisted thoracoscopic techniques may be performed.5 For traumatic transthoracic lung herniation, open or thoracoscopic implantation of surgical mesh is suggested, because it is rapidly applicable and shows favorable perioperative and late results.

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